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Prenatal Treatment of Pulmonary Stenosis

Approximately 36,000 babies are born each year with congenital heart problems. These are structural problems of the heart that are present at birth and the No. 1 cause of death from birth defects in the first year of life.

Pulmonary stenosis, the narrowing of the pulmonary valve, is just one of the many congenital heart defects, which can include holes in the heart, the lack of heart chambers or valve problems. The valve regulates the blood flow from the heart's right ventricle to the lungs.

  1. Effects

    • When the pulmonary valve narrows, the right ventricle has to pump harder to get blood past the blockage. The heart has to work harder, which can cause damage over time. For a fetus, the blockage can prevent the normal development of the right ventricle, which may lead to abnormal heart function after birth.

    Diagnosis

    • Pulmonary stenosis can be identified in utero using fetal echocardiography, ultrasound technology that photographs the heart. The echocardiogram allows assessment of heart tissue irregularities, including valve abnormalities or damage.

    Solutions

    • Pulmonary stenosis can be corrected in utero using state-of-the-science surgical techniques. In one procedure, a balloon catheter is inserted through the mother's abdomen and into the baby's grape-sized heart using a needle and then inflated to enlarge the obstructed pulmonary valve. Doctors rely on sonograms to ensure surgical accuracy while in utero.

    History

    • In 1978, Dr. Michael Harrison performed the first fetal surgery at the Fetal Treatment Center in San Francisco. It was an open fetus surgery, meaning the mother's abdomen was opened via incision and the fetus was then operated on. His methods have improved over more than two decades resulting in the image-guided surgical techniques used today.

    Considerations

    • Some congenital heart defects can be repaired after birth. However, the most severe defects, such as pulmonary stenosis, may not be fixable or may require a series of open-heart surgeries following birth. Even with surgery, congenital heart defects may still result in abnormal circulation.

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