胎儿先天性心脏病介入治疗进展

Advances in fetal cardiac interventional therapy

既往观点认为,一旦胎儿患有左心发育不良综合征(HLHS)等严重心血管畸形,结局就只能是出生后功能性单心室循环、心脏移植或中止妊娠。到目前为止,开放性胎儿心脏外科技术尚不成熟,而通过胎儿心脏介入治疗技术可以在很大程度上阻止因先天性心脏病引起的胎儿水肿、自发性流产或胎儿死亡,促进发育不良的心室重新发育,形成生后的双心室循环,重塑右室流出道梗阻胎儿的肺血管床等,改善了胎儿严重心血管畸形的预后。这些进步在很大程度上依赖于对胎儿先天性心脏病病理生理学特点的准确判断。超声技术的发展以及其他评价手段的进步可促进目前还比较有限的胎儿先天性心脏病介入治疗进一步发展。

Traditional therapeutic options for a fetus diagnosed with severe congenital heart diseases（CHD）, such as hypoplastic left heart syndrome（HLHS）, include staged surgical palliation to a functionally univentricular circulation, neonatal heart transplantation after birth, or termination of pregnancy. Open heart surgery in fetus has not yet been done successfully up to date. However, attempts of CHD fetal cardiac intervention are now being made to prevent fetal hydrops, spontaneous abortion, and fetus demise; to recruit hypoplastic ventricles; to create a two-ventricle circulation after birth; and to remodel the fetal pulmonary vascular bed whose outlet is obstructed. The outcomes will depend, in large part, on our knowledge of physiology and pathology of CHD. Evaluating the effects of the interventions requires deep understanding of these diseases, both on their natural and on unnatural courses. New ultrasound techniques and assessment tools to evaluate fetal cardiac wellness could enhance the limited progress in fetal cardiac intervention.