Rima S. Bader

Advances in fetal cardiac intervention

Fetal cardiac intervention is in a rapid state of progress now. Attemps are being made to prevent fetal hydrops due to congenital heart defects, to recruit hypoplastic ventricles, to create a two-ventricle circulation after birth, and to remodel the fetal pulmonary vascular bed whose outlet is obstructed. Open heart surgery in the fetus has yet to be done successfully, but interventions for improved cardiac outcomes are now being tested. Their outcomes will depend, in large part, on their successful physiological effects. How to measure these and quantitate the effects of our interventions will require further advances in the understanding of these diseases—both their natural and unnatural courses. New ultrasound techniques and assessment tools to assess fetal cardiac wellness could enhance the limited progress in fetal intervention in the heart so far.

Use of self expanding stents in stenotic aortopulmonary shunts in adults with complex cyanotic heart disease

OBJECTIVE To describe the use of self expanding stents in treating long segment stenosis of aortopulmonary shunts (APS) in adults. DESIGN Clinical records, catheterisation data, cineangiograms, and operation notes of four consecutive patients undergoing stent implantation since December 1994 were studied retrospectively. SETTING A tertiary referral centre for cardiac disease. SUBJECTS Four patients underwent cardiac catheterisation because of clinical deterioration. Their age ranged between 23 and 32 years. The underlying diagnosis was complex cyanotic heart disease in all. Three had a stenotic interposition graft, and one had a classic Blalock shunt. RESULTS There was one technical failure owing to migration of the stent distal to an ostial stenosis. The ability index, resting oxygen saturation, and exercise tolerance improved in the remainder. Their medium term results have been excellent. CONCLUSIONS This technique may further palliate adult patients with complex congenital heart disease, though the long term patency of stents is unknown.