Congenital heart defects can be diagnosed accurately during fetal life. This presents an opportunity for intra-uterine intervention to alter the natural history of the cardiac lesion. Such intervention has been advocated for critical aortic stenosis, pulmonary atresia and hypoplastic left heart with a severely restrictive or intact atrial septum. Technical success of intra-uterine intervention has been described since the early 1990s. Most experience has been gained in prenatal intervention for critical aortic stenosis but technical success has not been matched by a dramatic improvement in clinical outcome. Furthermore, there is a procedural risk for all interventions including preterm delivery or intra-uterine death. Better case selection and advances in postnatal management may in future permit continued overhaul of left heart structures to increase the proportion of cases achieving a good quality biventricular repair. Prenatal intervention should be regarded as one component of a program of surgery and catheter intervention for such infants, of whom some will remain better served by a single ventricle repair.
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