Surgery for congenital heart disease is now performed in the first months of life because mortality is higher and myocardial damage more serious in un-operated children or those undergoing delayed surgery. Fetal cardiac intervention may prove a logical extension. It has been proposed for fetuses with critical semilunar valve stenosis or atresia because early ventricular decompression may halt the progression, alter the natural history, and improve postnatal outcomes either by preserving a two-ventricle circulation or by improving the outlook for single ventricle candidates because of a healthier myocardium and pulmonary bed. Fetuses with a closed interatrial septum may develop circulatory failure resulting in hydrops and intrauterine death. In utero balloon atrial septostomy may stabilise the situation and increase duration of pregnancy.
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