An Early Change of Heart

Through the Fetal Cardiac Intervention Program, experts at NewYork-Presbyterian Morgan Stanley Children’s Hospital and Columbia University Irving Medical Center are now offering advanced fetal cardiac procedures. The goal is to lessen the severity and possibly even prevent the development of HLHS and other select fetal cardiac defects. The program is the first and only one of its kind in New York State.

The initiative is offered through the Center for Prenatal Pediatrics, which has a long history of treating complex congenital heart disorders in infants. Experts at the Center in fetal echocardiography, obstetrics, maternal fetal medicine, pediatric interventional cardiology, obstetric anesthesia, nursing, and other specialties collaborate to provide a comprehensive care plan for mothers and their unborn babies with congenital heart defects.

Guided via ultrasound, the advanced procedures offered through the program include:

• Fetal aortic balloon valvuloplasty for critical aortic stenosis with evolving HLHS (the most common fetal cardiac procedure).
• Fetal atrial septal stent implantation for infants who have already developed HLHS and have a restrictive/intact atrial septum.
• Fetal pulmonary balloon valvuloplasty for pulmonary valve atresia with intact ventricular septum.

Doctors at NYP/CUIMC caution that these procedures are not options for most patients. "The majority of babies are not candidates for these procedures due to anatomical limitations or because the diagnosis was made too late," explained Stéphanie Levasseur, MD, assistant professor of medicine at the Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian/Columbia University Irving Medical Center. Once the diagnosis is made, the team evaluates the infant and makes a decision quickly about whether a fetal procedure is possible and advantageous.

While most infants who receive these procedures still need additional cardiac procedures after birth, the in utero intervention may provide better circulation once the child is born and enable some children to opt for interventional procedures rather than surgery. "Fetal cardiac intervention does not preclude the need for other procedures, but we may be able to achieve better long-term outcomes than if a child was born with a single ventricle defect," noted Matthew Crystal, MD, associate professor of pediatrics at the Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian/Columbia University Irving Medical Center.

"Outcomes research is so important to gain a better understanding of which children are the best candidates for fetal cardiac intervention and how we can optimize the anatomy they're born with," Professor Crystal concluded.

Physicians interested in referring a patient to the Fetal Cardiac Intervention team or discussing a patient may call the Center for Prenatal Pediatrics at 212-305-3151.