Andersons pediatric cardiology 254
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FutureDirections
Ascandidateselectionandtechnicalmodificationsforthepreviouslymentioned
formsoffetalcardiacinterventioncontinuetoberefined,furtherfetalcardiac
therapiesareonthehorizon.Completeheartblockisaparticularlymorbid
diagnosisinthefetus,oftenleadingtohydropsanddemise,67despiteavarietyof
managementpractices.68,69Effortsareunderwaytodevelopaminimally
invasive,micropacemakerthatmaybeimplantedpercutaneouslyinthe
fetus.70,71Althoughstudiesremaininthepreclinicalphase,thedevelopmentof
miniaturizeddevicesmaylenditselftootherfetalapplications.
Beyondpercutaneousfetalcardiacintervention,anotheremergingformof
fetaltherapyismaternalhyperoxygenation(seealsoChapters7and8).Maternal
hyperoxygenationresultsinvasodilationofthefetalpulmonaryvascularbed
withincreasedpulmonarybloodflow,particularlylateringestation.Several
groupshaveinvestigatedtheuseofmaternalhyperoxygenationtoincrease
pulmonaryvenousreturnandthereforeflowthroughthemitralvalve,aortic
valve,andaorticarchinfetuseswithhypoplasticleftheartstructures.72–74
Althoughtheearlyresultsareencouraging,thistypeoftherapymightbe
applicableonlyinsituationsofreducedLVpreload,suchasprematurerestriction
orclosureoftheforamenovaleormildlyhypoplasticleftheartstructures
withoutdiscretevalvarstenosisorendocardialfibroelastosis.Furthermore,the
optimaldoseanddurationofmaternalhyperoxygenation,aswellasthepotential
sideeffectsofchronicoxygentherapytoboththemotherandthefetus,haveyet
tobedefined.
Asthefieldoffetaltherapyevolves,innovativestrategiesareunfoldingboth
withinandbeyondpercutaneousintervention.Hopefully,suchstrategieswill
poselessrisktoboththefetusandthemother.Multidisciplinarycollaboration
amongpediatriccardiologists,pediatriccardiacsurgeons,obstetricians/maternalfetalmedicinespecialists,anesthesiologists,andotherswillremainessentialnot
onlytoprovidethebestcarebutalsotomaintainthesafetyandautonomyofthe
motheratthecenterofthisneweraofscientificdiscovery.
AnnotatedReferences
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Pooledresultsofoutcomesofinuteroatrial
