Treatment of heart defects in the mother's womb is aimed at reducing the destructive consequences of a heart defect, which allows the duration of pregnancy to be extended and the baby to be born in a better condition. Usually, the pregnant woman is given special drugs, but more and more often, semi-invasive (percutaneous) therapy is performed, as well as intrauterine surgical treatment of some heart defects. Find out what is the prenatal treatment for heart defects.

Treatment of heart defects in the wombis not widely used yet, although it is becoming more and more popular. All because the risk of intrauterine or perinatal death of a child with a heart defect is very high, and percutaneous interventional procedures orintrauterine fetal surgerycan reduce this risk.

What is the treatment before childbirth?

Currentlytreatment in utero , i.e.before childbirthwith a heart defect, consists in administering medications or blood to the umbilical vein in pregnancy to terminate fetal tachycardia. Intrauterine transfusions are also an established treatment method.

The cardiological intervention in the fetus, which carries the lowest risk of complications, is the decompression of the pericardial sac. The heart is not touched during the procedure, and blood flow to this organ and large blood vessels is facilitated. In addition, better conditions for lung development are created.

Only in the case of the so-called for critical congenital heart defects that rapidly deteriorate the condition developing in the womb and threaten the life of the baby,prenatal intervention treatment of the fetus can be performed .Critical congenital anomalies of the heartare: critical aortic (SA) and pulmonary (PS) stenosis, left heart hypoplasia syndrome (HLHS) or great trunks transposition (TGA) with restrictive foramen oval (rest. Fo).

Percutaneous interventional procedures are only possible when diagnosed in a timely manner.

Prenatal interventional treatment of fetal heart defects

Percutaneous interventional proceduresare performed not to heal the defect, but to prevent heart failure, which may be the result of abnormalities in its structure.Therefore, the effect of this type of treatment is usually an increase in blood flow through the heart, and thus improving the functioning of the circulatory system.

Currently, the most common in the world is non-surgical procedures - balloon valvuloplasty of the aortic or pulmonary valve in fetuses. The aim of the first procedure is to widen the aortic valve and thus improve the function of the left ventricle. Balloon aortic valve valvuloplasty in fetuses involves the percutaneous insertion of a guide wire with a balloon catheter through the end of the left ventricle into the ascending aorta. In this way, the narrowed aortic valve, the surface of which is reduced, is effectively dilated. As a result, the flow of blood from the left ventricle to the aorta is facilitated.

Balloon valvuloplasty of the pulmonary valve is aimed at expanding the narrowing of the pulmonary valve and, consequently, improving the coronary circulation and leading to better development of individual parts of the right ventricle. Until 2007, 14 fetal pulmonary valvuloplasty procedures were performed on the 23.-30. week of pregnancy. It is known that 4 of them are still alive.

During this type of procedure, you can also insert transdermal clasps, implants or intravascular springs closing the defects in the heart, eliminating leaks or abnormal connections, for example in the case of a patent ductus arteriosus of Botalla.

Intrauterine correction of fetal malformations

Before the procedure, it is necessary to perform a test package. First, genetic tests are performed to rule out chromosomal aberrations that are a contraindication to open fetal surgery. Cardiotocography is also very important, the purpose of which is to assess the proper functioning of the fetal heart and the level of uterine muscle tone.

Fetal intrauterine surgeryis performed to reduce the destructive consequences of a heart defect, which allows for the improvement of the condition of the fetus, extending the duration of pregnancy and delivering newborn babies in a better general condition at term . These types of procedures are performed when a complete correction of a heart defect is necessary.

The intrauterine correction is usually performed by a team of doctors that includes a specialist surgeon - gynecologist - obstetrician, prenatal cardiologist, interventional cardiologist, anesthesiologist, neonatologist and other specialists. Only thanks to the cooperation of a multidisciplinary team can the risk of treatment failure be minimized.

Before such procedures, the mother is given general anesthesia, which also works for the fetus. Additionally, the fetus is administered a muscle relaxant intramuscularly to target hisimmobilization for the procedure.

Tocolysis is necessary after each interventional procedure - pharmacological treatment aimed at suppressing uterine contractions, which always occurs after manipulations on the pregnant uterus, and thus - preventing childbirth.

After the procedure, further treatments are necessary, but these are carried out immediately after the baby is born.

Several procedures were performed to correct the defects of the fetal heart valves by dilating them, which reduced the risk of serious problems with blood circulation, which threatened his intrauterine life.

Complications after the procedure

Surgical treatment in utero is not only associated with a high probability of failure, but also the risk of serious complications (rupture of membranes and, as a result, early delivery, drainage of amniotic fluid, bleeding).

Intrauterine treatment of fetal heart defects in Poland

Polish experience in the field of intrauterine treatment as well as prenatal cardiological interventions is small. Experience in carrying out this type of treatment has, among others, doctors from the Bielański Hospital in Warsaw.

The nearest clinic for this type of procedure is the Department of Pediatric Cardiology in Linz, Austria.

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