[Fetal life] [Expenses] [Survival] [Termination] [Natural Selection] [The Mother's Story] [What can we treat ?]

WHICH LESIONS ARE "CURABLE" ?

Fetal cardiac surgery is neither the "Holy Grail of Cardiac Surgery", nor a "Panacea of all heart ailments" ....not by a long way. In fact, surprisingly, there are not too many conditions which have been identified as "treatable" by fetal surgery.

The aim of fetal intervention should be to provide fetuses with heart defects, who had hitherto been "condemned-to-die", a meaningful chance of survival. Preserving heart muscle function, preventing progression of already existing changes (like a condition called FIBROELASTOSIS), and restoring a near-normal pattern of growth to the heart chambers and blood vessels are the targets of fetal surgery.

If this is achieved, then any future operations after the child is born could be fully reconstructive ones, done at a single stage and with reasonable chance of restoring a normal heart, and a normal life-span to the survivor. Contrast this with the present situation, where corrective operations for complex heart defects need to be done in multiple stages, each with its own risks and complications, and ultimately resulting in a life expectancy and a life-style considerably different from normal persons. That such ideals can be achieved is suggested by the encouraging results of animal experiments.

When should fetal surgery be performed ?
Timing of surgery is another controversial issue. The aim must be to identify fetuses with disease that is neither too mild to need intervention, nor too advanced to allow meaningful correction. Performing fetal surgery beyond 30 weeks of gestation may be difficult to justify in view of the higher risk to the mother. Also, even after surgery, significant growth or other beneficial changes in the fetal heart may not be expected so late in the pregnancy. If at all intervention is needed at this stage, it may be safer to electively deliver the infant, and treat the condition by neonatal surgery or catheter intervention.

And what conditions can we expect to cure ?
There seems to be a universal acceptance that fetal surgery will help in treating hypoplastic left and right heart syndromes, and valvar atresias or stenoses. Being extremely rare, of far smaller surgical significance are lesions like primary obstruction of the foramen ovale, ductus arteriosus, tetralogy of Fallot with absent pulmonary valve or complete heart block

But then, all this so far is armchair - reasoning. Historically, when heart and lung bypass (called "Cardio-Pulmonary Bypass" or CPB) became clinically applicable, there was a virtual explosion of new operations, treating conditions that no one had even dreamed were correctable just a few years before that.

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