Advances in prenatal interventional treatment for fetal congenital heart disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HU luoming ^1,2 ,  YUAN Haiyun ^1,2 ,  CHEN Jimei ^1,2

1. Department of Cardiothoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510515, P. R. China;
2. Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, P. R. China;

Corresponding author：

YUAN Haiyun, Email: yhy_yun@163.com; CHEN Jimei, Email: jimei_1965@outlook.com

Keywords：

Fetal congenital heart disease; prenatal intervention; fetal aortic valvuloplasty (FAV); fetal pulmonary valvuloplasty (FPV); fetal cardiac intervention (FCI); review

DOI：

10.7507/1007-4848.202412022

Video：

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Abstract Full text Figures/Tables Video References Cited by

This review provides an overview of prenatal interventional treatments for fetal congenital heart disease (CHD), with a particular focus on the latest advancements in fetal aortic valvuloplasty (FAV) and fetal pulmonary valvuloplasty (FPV). FAV aims to improve left heart hemodynamics, prevent hypoplastic left heart syndrome (HLHS), and promote biventricular circulation. FPV seeks to improve the natural history of pulmonary atresia with intact ventricular septum (PA/IVS) and critical pulmonary stenosis with intact ventricular septum (CPS/IVS), alleviate right ventricular outflow tract obstruction, and promote biventricular circulation. This article discusses patient selection, technical details, risk assessment, and clinical outcomes for these procedures, highlighting the challenges in current research, including the lack of standardized patient selection criteria and long-term prognostic studies. Additionally, it emphasizes the opportunities and challenges of fetal cardiac intervention (FCI) development in China and proposes recommendations for future improvements and research directions.

1.	Zhang Y, Wang J, Zhao J, et al. Current status and challenges in prenatal and neonatal screening, diagnosis, and management of congenital heart disease in China. The Lancet Child & Adolescent Health, 2023, 7(7): 479-489.
2.	Gardiner HM, Kovacevic A, Tulzer G, et al. Natural history of 107 cases of fetal aortic stenosis from a European multicenter retrospective study. Ultrasound Obstet Gynecol, 2016, 48(3): 373-381.
3.	Makikallio K, McElhinney DB, Levine JC, et al. Fetal aortic valve stenosis and the evolution of hypoplastic left heart syndrome: patient selection for fetal intervention. Circulation, 2006, 113(11): 1401-1405.
4.	Zhao QM, Liu F, Wu L, et al. Prevalence of Congenital Heart Disease at Live Birth in China. J Pediatr, 2019, 204: 53-58.
5.	Van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: A systematic review and meta-analysis. J Am Coll Cardiol, 2011, 58(21): 2241-2247.
6.	Yuan SM, Humuruola G. Fetal cardiac interventions: clinical and experimental research. Postepy Kardiol Interwencyjnej, 2016, 12(2): 99-107.
7.	Bradford V R, Tworetzky W, Callahan R, et al. Hemodynamic and anatomic changes after fetal aortic valvuloplasty are associated with procedural success and postnatal biventricular circulation. Prenat Diagn, 2022, 42(10): 1312-1322.
8.	Tulzer G, Arzt W, Franklin R C, et al. Fetal pulmonary valvuloplasty for critical pulmonary stenosis or atresia with intact septum. Lancet, 2002, 360(9345): 1567-1568.
9.	Tulzer A, Arzt W, Gitter R, et al. Valvuloplasty in 103 fetuses with critical aortic stenosis: outcome and new predictors for postnatal circulation. Ultrasound Obstet Gynecol, 2022, 59(5): 633-641.
10.	Friedman KG, Sleeper LA, Freud LR, et al. Improved technical success, postnatal outcome and refined predictors of outcome for fetal aortic valvuloplasty. Ultrasound Obstet Gynecol, 2018, 52(2): 212-220.
11.	Kovacevic A, Ohman A, Tulzer G, et al. Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: A European multicenter study. Ultrasound Obstet Gynecol, 2018, 52(2): 221-229.
12.	Maxwell D, Lallan L, Tynan MJ. Balloon dilatation of the aortic valve in the fetus: A report of two cases. Br Heart J, 1991, 65(5): 256-258.
13.	Kohl T, Sharland G, Allan LD, et al. World experience of percutaneous ultrasound-guided balloon valvuloplasty in human fetuses with severe aortic valve obstruction. Am J Cardiol, 2000, 85(10): 1230-1233.
14.	Mendel B, Kohar K, Amirah S, et al. The outcomes of fetal aortic valvuloplasty in critical aortic stenosis: A systematic review and meta-analysis. Int J Cardiol, 2023, 382: 106-111.
15.	McElhinney DB, Marshall AC, Wilkins-Haug LE, et al. Predictors of technical success and postnatal biventricular outcome after in utero aortic valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome. Circulation, 2009, 120(15): 1482-1490.
16.	Zhao L, Wang L, Xia H, et al. Prognosis and outcome of intrauterine treatment of fetuses with critical congenital heart disease. Chin Med J (Engl), 2024, 137(12): 1431-1436.
17.	Galindo A, Gomez-Montes E, Gomez O, et al. Fetal aortic valvuloplasty: Experience and results of two tertiary centers in spain. Fetal Diagn Ther, 2017, 42(4): 262-270.
18.	Crystal MA, Freud LR. Fetal aortic valvuloplasty to prevent progression to hypoplastic left heart syndrome in utero. Birth Defects Res, 2019, 111(8): 389-394.
19.	Tworetzky W, Wilkins-Haug L, Jennings R W, et al. Balloon dilation of severe aortic stenosis in the fetus: Potential for prevention of hypoplastic left heart syndrome: Candidate selection, technique, and results of successful intervention. Circulation, 2004, 110(15): 2125-2131.
20.	Wohlmuth C, Tulzer G, Arzt W, et al. Maternal aspects of fetal cardiac intervention. Ultrasound Obstet Gynecol, 2014, 44(5): 532-537.
21.	Freud LR, McElhinney DB, Marshall AC, et al. Fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome: Postnatal outcomes of the first 100 patients. Circulation, 2014, 130(8): 638-645.
22.	Pickard SS, Wong JB, Bucholz EM, et al. Fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome: a decision analysis. Circ Cardiovasc Qual Outcomes, 2020, 13(4): e006127.
23.	Arzt W, Wertaschnigg D, Veit I, et al. Intrauterine aortic valvuloplasty in fetuses with critical aortic stenosis: Experience and results of 24 procedures. Ultrasound Obstet Gynecol, 2011, 37(6): 689-695.
24.	Moon-Grady AJ, Morris SA, Belfort M, et al. International fetal cardiac intervention registry: A worldwide collaborative description and preliminary outcomes. J Am Coll Cardiol, 2015, 66(4): 388-399.
25.	Corroenne R, Meot M, Salomon L J, et al. Postnatal outcome following fetal aortic valvuloplasty for critical aortic stenosis. Ultrasound Obstet Gynecol, 2024, 64(3): 339-347.
26.	Vorisek C N, Zurakowski D, Tamayo A, et al. Postnatal circulation in patients with aortic stenosis undergoing fetal aortic valvuloplasty: systematic review and meta-analysis. Ultrasound Obstet Gynecol, 2022, 59(5): 576-584.
27.	Pang C, Wang Y, Shen J, et al. Echocardiographic characteristics and clinical outcomes in fetuses with pulmonary stenosis or pulmonary atresia with intact ventricular septum. Pediatr Neonatol, 2024, 65(4): 328-335.
28.	Mendel B, Kohar K, Yumnanisha DA, et al. Impact of fetal pulmonary valvuloplasty in in-utero critical pulmonary stenosis: A systematic review and meta-analysis. Int J Cardiol Congenit Heart Dis, 2024, 15: 100485.
29.	Pang C, Zhou C, Zhang Z, et al. Fetal pulmonary valvuloplasty in fetuses with right ventricular outflow tract obstructive disease: Experience and outcome of the first five cases in China. Pediatr Cardiol, 2021, 42(2): 340-348.
30.	孙路明, 孟梦, 吴凤钰, 等. 胎儿肺动脉瓣球囊成形术成功1例. 中华妇产科杂志, 2019, 54(2): 123-124.Sun L, Meng M, Wu F, et al. Case of successful fetal pulmonary valve balloon atrioventricular septoplasty. Chin J Obstet, 2019, 54(2): 123-124.
31.	张蔼, 孙越, 陈涛涛, 等. 孕26周胎儿肺动脉闭锁宫内介入治疗1例并文献复习. 精准医学杂志, 2018, 33(4): 292-294, 299.Zhang A, Sun Y, Chen T, et al. Intrauterine cardiac intervention for fetal pulmonary atresia at a gestational age of 26 weeks : A case report and literature review. J Precis Med, 2018, 33(4): 292-294, 299.
32.	Freud L R, Tworetzky W. Fetal interventions for congenital heart disease. Curr Opin Pediatr, 2016, 28(2): 156-162.
33.	Tworetzky W, McElhinney DB, Marx GR, et al. In utero valvuloplasty for pulmonary atresia with hypoplastic right ventricle: techniques and outcomes. Pediatrics, 2009, 124(3): e510-e518.
34.	Gomez Montes E, Herraiz I, Mendoza A, et al. Fetal intervention in right outflow tract obstructive disease: selection of candidates and results. Cardiol Res Pract, 2012, 2012: 592403.
35.	Roman KS, Fouron JC, Nii M, et al. Determinants of outcome in fetal pulmonary valve stenosis or atresia with intact ventricular septum. Am J Cardiol, 2007, 99(5): 699-703.
36.	Gottschalk I, Strizek B, Menzel T, et al. Severe pulmonary stenosis or atresia with intact ventricular septum in the fetus: The natural history. Fetal Diagn Ther, 2020, 47(5): 420-428.
37.	Jaeggi E, Renaud C, Ryan G, et al. Intrauterine therapy for structural congenital heart disease: Contemporary results and Canadian experience. Trends Cardiovasc Med, 2016, 26(7): 639-646.
38.	泮思林. 我国胎儿先天性心脏病介入治疗的探索和展望. 介入放射学杂志, 2019, 28(10): 917-922.Pan S. Exploration and prospect of interventional therapy for fetal congenital heart diseases in China. J Intervent Radio, 2019, 28(10): 917-922.
39.	Debska M, Kolesnik A, Rebizant B, et al. Fetal cardiac interventions-polish experience from "Zero" to the third world largest program. J Clin Med, 2020, 9(9): 2888.
40.	Luo G, Zhang B, Wang D, et al. Fetal pulmonary valvuloplasty for pulmonary atresia with intact ventricular septum: a single-center clinical experience. Chin Med J (Engl), 2023, 136(6): 740-742.
41.	Yu JJ, Pan W, Zhang ZW, et al. Intrauterine cardiac intervention for fetal pulmonary valve obstruction lesion. Chin Med J (Engl), 2018, 131(1): 103-104.
42.	Hogan W J, Grinenko S, Armstrong A, et al. Fetal cardiac intervention for pulmonary atresia with intact ventricular septum: international fetal cardiac intervention registry. Fetal Diagn Ther, 2020: 1-9.
43.	Tulzer A, Arzt W, Gitter R, et al. Immediate effects and outcome of in-utero pulmonary valvuloplasty in fetuses with pulmonary atresia with intact ventricular septum or critical pulmonary stenosis. Ultrasound Obstet Gynecol, 2018, 52(2): 230-237.
44.	Luo G, Gao S, Sun H, et al. Valvuloplasty of fetal pulmonary atresia with intact ventricular septum and hypoplastic right heart: Mid-term follow-up results. J Interv Med, 2022, 5(4): 196-199.
45.	Luo G, Pan SL. Progress in fetal cardiac intervention for hypoplastic right heart syndrome. Zhonghua Er Ke Za Zhi, 2024, 62(6): 583-586.
46.	Wolter A, Markert N, Wolter J S, et al. Natural history of pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS) and prediction of outcome. Arch Gynecol Obstet, 2021, 304(1): 81-90.
47.	Luo G, Liu N, Wang KL, et al. Immediate and short-time outcomes of pulmonary valvuloplasty in a fetus with pulmonary atresia. Chin Med J (Engl). 2019, 132(14): 758-1759.
48.	Luo G, Pan SL. Progress in fetal cardiac intervention for hypoplastic right heart syndrome. Zhonghua Er Ke Za Zhi, 2024, 62(6): 583-586.
49.	蔡蕾裔, 赵莉晴, 王磊, 等. 宫内心脏介入治疗胎儿危重型先天性心脏病5例报告. 临床儿科杂志, 2024, 42(1): 35-39.Cai L, Zhao L, Wang L, et al. Fetal cardiac intervention for critical congenital heart disease of fetus: a report of 5 cases. J Clin Pediatr, 2024, 42(1): 35-39.
50.	MARSHALL A C, LEVINE J, MORASH D, et al. Results of in utero atrial septoplasty in fetuses with hypoplastic left heart syndrome. Prenat Diagn, 2008, 28(11): 1023-8.
51.	罗刚, 张蔼, 陈涛涛, 等. 孕27周胎儿左心发育不良综合征-限制性房间隔缺损宫内介入治疗1例. 中华实用儿科临床杂志, 2019, 34(13): 1025-1026.Luo G, Zhang A, Chen TT. Intrauterine interventional therapy for fetal hypoplastic left heart syndrome with restrictive atrial septum at 27 gestational week: a case report. 2019, 34(13): 1025-1026.
52.	Mustafa H J, Agajani F, Jawwad M, et al. Fetal cardiac intervention in hypoplastic left heart syndrome with intact or restrictive atrial septum, systematic review, and meta-analysis. Prenat Diagn, 2024, 44(6-7): 747-757.
53.	滕云, 黄冰鑫, 陈寄梅. 胎儿先天性心脏病的治疗现状和研究进展. 中华胸心血管外科杂志, 2021, 42(1): 443-446.Teng Y, Huang B, Chen J. Current situation of treatment and research progress of fetal congenital heart disease. Chin J Thorac Cardiovasc Surg, 2021, 42(1): 443-446.

1. Zhang Y, Wang J, Zhao J, et al. Current status and challenges in prenatal and neonatal screening, diagnosis, and management of congenital heart disease in China. The Lancet Child & Adolescent Health, 2023, 7(7): 479-489.
2. Gardiner HM, Kovacevic A, Tulzer G, et al. Natural history of 107 cases of fetal aortic stenosis from a European multicenter retrospective study. Ultrasound Obstet Gynecol, 2016, 48(3): 373-381.
3. Makikallio K, McElhinney DB, Levine JC, et al. Fetal aortic valve stenosis and the evolution of hypoplastic left heart syndrome: patient selection for fetal intervention. Circulation, 2006, 113(11): 1401-1405.
4. Zhao QM, Liu F, Wu L, et al. Prevalence of Congenital Heart Disease at Live Birth in China. J Pediatr, 2019, 204: 53-58.
5. Van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: A systematic review and meta-analysis. J Am Coll Cardiol, 2011, 58(21): 2241-2247.
6. Yuan SM, Humuruola G. Fetal cardiac interventions: clinical and experimental research. Postepy Kardiol Interwencyjnej, 2016, 12(2): 99-107.
7. Bradford V R, Tworetzky W, Callahan R, et al. Hemodynamic and anatomic changes after fetal aortic valvuloplasty are associated with procedural success and postnatal biventricular circulation. Prenat Diagn, 2022, 42(10): 1312-1322.
8. Tulzer G, Arzt W, Franklin R C, et al. Fetal pulmonary valvuloplasty for critical pulmonary stenosis or atresia with intact septum. Lancet, 2002, 360(9345): 1567-1568.
9. Tulzer A, Arzt W, Gitter R, et al. Valvuloplasty in 103 fetuses with critical aortic stenosis: outcome and new predictors for postnatal circulation. Ultrasound Obstet Gynecol, 2022, 59(5): 633-641.
10. Friedman KG, Sleeper LA, Freud LR, et al. Improved technical success, postnatal outcome and refined predictors of outcome for fetal aortic valvuloplasty. Ultrasound Obstet Gynecol, 2018, 52(2): 212-220.
11. Kovacevic A, Ohman A, Tulzer G, et al. Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: A European multicenter study. Ultrasound Obstet Gynecol, 2018, 52(2): 221-229.
12. Maxwell D, Lallan L, Tynan MJ. Balloon dilatation of the aortic valve in the fetus: A report of two cases. Br Heart J, 1991, 65(5): 256-258.
13. Kohl T, Sharland G, Allan LD, et al. World experience of percutaneous ultrasound-guided balloon valvuloplasty in human fetuses with severe aortic valve obstruction. Am J Cardiol, 2000, 85(10): 1230-1233.
14. Mendel B, Kohar K, Amirah S, et al. The outcomes of fetal aortic valvuloplasty in critical aortic stenosis: A systematic review and meta-analysis. Int J Cardiol, 2023, 382: 106-111.
15. McElhinney DB, Marshall AC, Wilkins-Haug LE, et al. Predictors of technical success and postnatal biventricular outcome after in utero aortic valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome. Circulation, 2009, 120(15): 1482-1490.
16. Zhao L, Wang L, Xia H, et al. Prognosis and outcome of intrauterine treatment of fetuses with critical congenital heart disease. Chin Med J (Engl), 2024, 137(12): 1431-1436.
17. Galindo A, Gomez-Montes E, Gomez O, et al. Fetal aortic valvuloplasty: Experience and results of two tertiary centers in spain. Fetal Diagn Ther, 2017, 42(4): 262-270.
18. Crystal MA, Freud LR. Fetal aortic valvuloplasty to prevent progression to hypoplastic left heart syndrome in utero. Birth Defects Res, 2019, 111(8): 389-394.
19. Tworetzky W, Wilkins-Haug L, Jennings R W, et al. Balloon dilation of severe aortic stenosis in the fetus: Potential for prevention of hypoplastic left heart syndrome: Candidate selection, technique, and results of successful intervention. Circulation, 2004, 110(15): 2125-2131.
20. Wohlmuth C, Tulzer G, Arzt W, et al. Maternal aspects of fetal cardiac intervention. Ultrasound Obstet Gynecol, 2014, 44(5): 532-537.
21. Freud LR, McElhinney DB, Marshall AC, et al. Fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome: Postnatal outcomes of the first 100 patients. Circulation, 2014, 130(8): 638-645.
22. Pickard SS, Wong JB, Bucholz EM, et al. Fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome: a decision analysis. Circ Cardiovasc Qual Outcomes, 2020, 13(4): e006127.
23. Arzt W, Wertaschnigg D, Veit I, et al. Intrauterine aortic valvuloplasty in fetuses with critical aortic stenosis: Experience and results of 24 procedures. Ultrasound Obstet Gynecol, 2011, 37(6): 689-695.
24. Moon-Grady AJ, Morris SA, Belfort M, et al. International fetal cardiac intervention registry: A worldwide collaborative description and preliminary outcomes. J Am Coll Cardiol, 2015, 66(4): 388-399.
25. Corroenne R, Meot M, Salomon L J, et al. Postnatal outcome following fetal aortic valvuloplasty for critical aortic stenosis. Ultrasound Obstet Gynecol, 2024, 64(3): 339-347.
26. Vorisek C N, Zurakowski D, Tamayo A, et al. Postnatal circulation in patients with aortic stenosis undergoing fetal aortic valvuloplasty: systematic review and meta-analysis. Ultrasound Obstet Gynecol, 2022, 59(5): 576-584.
27. Pang C, Wang Y, Shen J, et al. Echocardiographic characteristics and clinical outcomes in fetuses with pulmonary stenosis or pulmonary atresia with intact ventricular septum. Pediatr Neonatol, 2024, 65(4): 328-335.
28. Mendel B, Kohar K, Yumnanisha DA, et al. Impact of fetal pulmonary valvuloplasty in in-utero critical pulmonary stenosis: A systematic review and meta-analysis. Int J Cardiol Congenit Heart Dis, 2024, 15: 100485.
29. Pang C, Zhou C, Zhang Z, et al. Fetal pulmonary valvuloplasty in fetuses with right ventricular outflow tract obstructive disease: Experience and outcome of the first five cases in China. Pediatr Cardiol, 2021, 42(2): 340-348.
30. 孙路明, 孟梦, 吴凤钰, 等. 胎儿肺动脉瓣球囊成形术成功1例. 中华妇产科杂志, 2019, 54(2): 123-124.Sun L, Meng M, Wu F, et al. Case of successful fetal pulmonary valve balloon atrioventricular septoplasty. Chin J Obstet, 2019, 54(2): 123-124.
31. 张蔼, 孙越, 陈涛涛, 等. 孕26周胎儿肺动脉闭锁宫内介入治疗1例并文献复习. 精准医学杂志, 2018, 33(4): 292-294, 299.Zhang A, Sun Y, Chen T, et al. Intrauterine cardiac intervention for fetal pulmonary atresia at a gestational age of 26 weeks : A case report and literature review. J Precis Med, 2018, 33(4): 292-294, 299.
32. Freud L R, Tworetzky W. Fetal interventions for congenital heart disease. Curr Opin Pediatr, 2016, 28(2): 156-162.
33. Tworetzky W, McElhinney DB, Marx GR, et al. In utero valvuloplasty for pulmonary atresia with hypoplastic right ventricle: techniques and outcomes. Pediatrics, 2009, 124(3): e510-e518.
34. Gomez Montes E, Herraiz I, Mendoza A, et al. Fetal intervention in right outflow tract obstructive disease: selection of candidates and results. Cardiol Res Pract, 2012, 2012: 592403.
35. Roman KS, Fouron JC, Nii M, et al. Determinants of outcome in fetal pulmonary valve stenosis or atresia with intact ventricular septum. Am J Cardiol, 2007, 99(5): 699-703.
36. Gottschalk I, Strizek B, Menzel T, et al. Severe pulmonary stenosis or atresia with intact ventricular septum in the fetus: The natural history. Fetal Diagn Ther, 2020, 47(5): 420-428.
37. Jaeggi E, Renaud C, Ryan G, et al. Intrauterine therapy for structural congenital heart disease: Contemporary results and Canadian experience. Trends Cardiovasc Med, 2016, 26(7): 639-646.
38. 泮思林. 我国胎儿先天性心脏病介入治疗的探索和展望. 介入放射学杂志, 2019, 28(10): 917-922.Pan S. Exploration and prospect of interventional therapy for fetal congenital heart diseases in China. J Intervent Radio, 2019, 28(10): 917-922.
39. Debska M, Kolesnik A, Rebizant B, et al. Fetal cardiac interventions-polish experience from "Zero" to the third world largest program. J Clin Med, 2020, 9(9): 2888.
40. Luo G, Zhang B, Wang D, et al. Fetal pulmonary valvuloplasty for pulmonary atresia with intact ventricular septum: a single-center clinical experience. Chin Med J (Engl), 2023, 136(6): 740-742.
41. Yu JJ, Pan W, Zhang ZW, et al. Intrauterine cardiac intervention for fetal pulmonary valve obstruction lesion. Chin Med J (Engl), 2018, 131(1): 103-104.
42. Hogan W J, Grinenko S, Armstrong A, et al. Fetal cardiac intervention for pulmonary atresia with intact ventricular septum: international fetal cardiac intervention registry. Fetal Diagn Ther, 2020: 1-9.
43. Tulzer A, Arzt W, Gitter R, et al. Immediate effects and outcome of in-utero pulmonary valvuloplasty in fetuses with pulmonary atresia with intact ventricular septum or critical pulmonary stenosis. Ultrasound Obstet Gynecol, 2018, 52(2): 230-237.
44. Luo G, Gao S, Sun H, et al. Valvuloplasty of fetal pulmonary atresia with intact ventricular septum and hypoplastic right heart: Mid-term follow-up results. J Interv Med, 2022, 5(4): 196-199.
45. Luo G, Pan SL. Progress in fetal cardiac intervention for hypoplastic right heart syndrome. Zhonghua Er Ke Za Zhi, 2024, 62(6): 583-586.
46. Wolter A, Markert N, Wolter J S, et al. Natural history of pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS) and prediction of outcome. Arch Gynecol Obstet, 2021, 304(1): 81-90.
47. Luo G, Liu N, Wang KL, et al. Immediate and short-time outcomes of pulmonary valvuloplasty in a fetus with pulmonary atresia. Chin Med J (Engl). 2019, 132(14): 758-1759.
48. Luo G, Pan SL. Progress in fetal cardiac intervention for hypoplastic right heart syndrome. Zhonghua Er Ke Za Zhi, 2024, 62(6): 583-586.
49. 蔡蕾裔, 赵莉晴, 王磊, 等. 宫内心脏介入治疗胎儿危重型先天性心脏病5例报告. 临床儿科杂志, 2024, 42(1): 35-39.Cai L, Zhao L, Wang L, et al. Fetal cardiac intervention for critical congenital heart disease of fetus: a report of 5 cases. J Clin Pediatr, 2024, 42(1): 35-39.
50. MARSHALL A C, LEVINE J, MORASH D, et al. Results of in utero atrial septoplasty in fetuses with hypoplastic left heart syndrome. Prenat Diagn, 2008, 28(11): 1023-8.
51. 罗刚, 张蔼, 陈涛涛, 等. 孕27周胎儿左心发育不良综合征-限制性房间隔缺损宫内介入治疗1例. 中华实用儿科临床杂志, 2019, 34(13): 1025-1026.Luo G, Zhang A, Chen TT. Intrauterine interventional therapy for fetal hypoplastic left heart syndrome with restrictive atrial septum at 27 gestational week: a case report. 2019, 34(13): 1025-1026.
52. Mustafa H J, Agajani F, Jawwad M, et al. Fetal cardiac intervention in hypoplastic left heart syndrome with intact or restrictive atrial septum, systematic review, and meta-analysis. Prenat Diagn, 2024, 44(6-7): 747-757.
53. 滕云, 黄冰鑫, 陈寄梅. 胎儿先天性心脏病的治疗现状和研究进展. 中华胸心血管外科杂志, 2021, 42(1): 443-446.Teng Y, Huang B, Chen J. Current situation of treatment and research progress of fetal congenital heart disease. Chin J Thorac Cardiovasc Surg, 2021, 42(1): 443-446.

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