Fetal Surgery May Treat Heart Defect

Sept. 30 -- TUESDAY, Sept. 29 (HealthDay News) -- Infants born with a rare heart defect may have better outcomes when surgery to repair the heart is done while the infant is still in the womb, Harvard University researchers say.

The condition, hypoplastic left heart syndrome, occurs when the fetus's left ventricle is underdeveloped and the heart cannot pump enough blood to sustain life. It affects about 1 in 10,000 newborns, and without open-heart surgery within a week of birth, these infants face death. Even with the heart repair, the children lead restricted lives and need at least one heart transplant, researchers say.

"Using the new procedure, in about 30 percent of the fetuses [with technically successful operations], there was an outcome of a two-ventricle circulation after birth," said Dr. Doff B. McElhinney, an assistant professor of pediatrics at Harvard Medical School and an associate in cardiology at Children's Hospital Boston.

The findings appear online Sept. 28 in Circulation.

How well the infants in the study will fare over the long term isn't known, but the researchers intend to follow them as they grow up, McElhinney said.

In fetuses, aortic stenosis usually progresses to hypoplastic left heart syndrome, the study explains. Prenatal intervention could reduce the total number of surgeries required over a lifetime, eliminate the need for a heart transplant and possibly improve the children's quality of life, he said.

According to the study, 51 of 68 procedures were considered technically successful, and 17 infants (33 percent of the 51) were born with a fully functioning heart.

The operation involves threading a catheter through the mother's abdomen into the fetus's heart. A balloon at the end of the catheter enlarges the aortic valve that controls blood flow from the left ventricle into the aorta and then into the body, McElhinney explained.

Over seven years, the researchers were able to establish criteria to determine which infants were likely to benefit from the procedure, which would not and when the operation would be most likely to succeed, McElhinney said. "This enables us to focus it more, and expose fewer mothers and fetuses to the risks of the procedure," he said.