ABSTRACT
Introduction Advances in fetal echocardiography have facilitated our understanding of the natural history of cardiac disease in utero. This knowledge, coupled with improvements in interventional obstetric and catheterization techniques, has led to the advent of minimally invasive percutaneous fetal cardiac intervention (FCI). Since the first report of FCI by Maxwell et al. in London in 1991,1 the field has evolved considerably. The goal is to alter the natural history of fetuses with severe anomalies that lead to significant lifelong morbidity and mortality, i.e., staged univentricular palliation, and/or improve survival in fetuses with lethal anomalies. We will focus on the three most common forms of congenital heart disease for which minimally invasive percutaneous FCI is currently performed: severe aortic stenosis (AS) with evolving hypoplastic left heart syndrome (HLHS), pulmonary atresia with intact ventricular septum (PA/IVS) and evolving hypoplastic right heart syndrome (HRHS), and established HLHS with intact or highly restrictive atrial septum (IAS). Finally, the emerging possibility of maternal hyperoxygenation as a form of fetal therapy is discussed. The maternal aspects of fetal therapy, which are essential to consider, are beyond the scope of this chapter.
