Pediatric Cardiology

Biography

Biography: Renato Samy Assad

Abstract

Fetal therapy has become the frontier in pediatric cardiology. There is increasing evidence that some of heart defects may benefit from fetal interventions. Cardiac anatomy can now be accurately imaged by means of prenatal echocardiography as early as the twelfth week of gestation. Because the growth and development of the heart in utero are greatly affected by blood flow patterns, repair of some lesions in the fetus may provide a better anatomic and functional outcome. If we want to modify the course of cardiac growth, function, and/or development in utero sufficiently to alter postnatal outcome and justify the potential risks of the procedure, we must take advantage of this developmental period when there is enhanced wound healing and the capacity for myocyte proliferation.
Research on fetal cardiac surgery has been performed for almost four decades. The major focus of investigation has been the pathophysiology of fetal cardiac bypass, for the purposes of open fetal cardiac surgery. The most significant unwanted response is placental dysfunction. A deleterious fetal stress response may account for poor outcomes after fetal cardiac surgery. Experimental studies in the fetal lamb model have been looking for the ideal fetal anesthesia during surgical exposure and cardiac bypass to block the stress response, not cause fetal myocardial depression, and prevent placental dysfunction. From a clinical perspective, continuous research of improving placental blood flow will be critical to the success of fetal cardiac bypass and, in turn, to the correction of congenital heart defects prenatally.