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This chapter summarizes the current state of trans-catheter fetal cardiac interventions (FCI) for a select group of congenital heart defects (CHDs). The ethical issues and risks that pertain to the mother, as the healthy patient and innocent bystander are non-trivial. However, there are other situations in medical therapy that involve procedures to a healthy patient for the sake of another. Therapy for FCI involves ultrasound-guided uterine and fetal cardiac puncture with an 18- or 19-gauge cannula, predominantly percutaneous, and can be performed with the mother awake. The fetal cardiac lesion that has been the main focus of FCI over the past two decades is severe aortic stenosis (AS) in early and mid-gestation that has been shown in several publications to evolve into HLHS at birth. Hypoplastic left heart syndrome (HLHS) with highly restrictive or intact atrial septum (IAS) is one of the most challenging lesions in managing patients with CHD.
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