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(Circulation. 2006;113:1378-1381.)
© 2006 American Heart Association, Inc.

Editorial

Fetal Cardiac Intervention

Innovative Therapy or a Technique in Search of an Indication?

Charles S. Kleinman, MD

From the Center for Prenatal Pediatrics, Division of Pediatric Cardiology, The Morgan Stanley Children’s Hospital of New York–Presbyterian, Columbia University College of Physicians and Surgeons, Weill Medical College of Cornell University, New York, NY.

Correspondence to Charles S. Kleinman, MD, Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children’s Hospital of New York–Presbyterian, Babies Hospital 2-North, 3959 Broadway, New York, NY 10032. E-mail ck2098@columbia.edu

Key Words: Editorials • heart defects, congenital • fetal hearts • aortic stenosis • balloon valvuloplasty

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Imaging of the fetal heart to diagnose congenital heart disease has become commonplace during the past 30 years, to the point that institutions such as the American College of Obstetrics and Gynecology, the American College of Radiology, and the American Institute of Ultrasound in Medicine have established, as a standard of care, routine screening for congenital heart disease in the scanning protocol of fetuses undergoing ultrasound study for any reason during the second or third trimester of pregnancy.

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Until recently, the parents of fetuses diagnosed with congenital heart disease have had to face the limited but difficult decisions of continuation or termination of the pregnancy for these offspring and, when the pregnancy was continued, the decision of where, when, and how to deliver and whether to seek aggressive medical and surgical therapy during the neonatal period. More recently, however, the option of catheter intervention to alter the natural history of fetal aortic stenosis or pulmonary atresia has been offered at several medical centers.^1–5 Although attempting to prevent the progression of aortic stenosis into hypoplastic left heart syndrome (HLHS) on its surface might appear to be an obvious choice, it should be noted that by engaging in fetal therapy, the pediatric cardiology community as a group is entering a field with complex and unique legal and ethical underpinnings that have been formulated during a period of more than 35 years. Unless the pediatric cardiology community takes note of the experiences of our colleagues in maternal-fetal medicine and pediatric . . . [Full Text of this Article]

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