Childen's Hospital Boston 300 Longwood Avenue
Boston, MA 02115
(617) 355-6000
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Clinical Services (Fetal Cardiology Program):
Fetal Therapy
Children's has established itself as one of the preeminent hospitals in the world for fetal heart surgeries. Fetal heart surgeries are procedures that attempt to correct a baby's heart defect while still in their mother's womb.
When is fetal therapy the best option?
Most cardiovascular defects are best treated after birth. However, for a select group of heart defects, in utero therapy may be an option. Recent advances in methods of prenatal diagnosis and ultrasound guided surgical and catheterization techniques have made fetal therapy possible.

Fetal therapy is performed with the intention of improving or correcting problems that would be too advanced to correct after birth.

Children's Hospital Boston is at the forefront of ultrasound-guided surgery/interventions and has performed these in utero procedures with increasing success.

Types of defects that may require fetal therapy
The Fetal Cardiology Program at Children's treats both fetal heart rhythm problems and structural heart defects:

Fetal heart rhythm problems
Fetal heart rhythm problems (arrhythmias) respond well to therapy, if needed, while still in utero. Our fetal cardiologists (echocardiographers and electrophysiologists) work together to monitor and treat potentially life threatening fetal arrhythmias.

Examples of fetal heart rhythm problems may include:

  • Supraventricular tachycardia (SVT) — most common serious fetal arrhythmia
  • Atrial Flutter — less common
Structural heart defects
Fetal therapy may be an option for a select group of structural heart defects. Examples of these defects include:
  • Aortic Stenosis: This is a thickening and narrowing of the aortic valve of the heart that obstructs the outflow of blood from the left ventricle. The severe form of aortic stenosis can lead to significant damage to the left ventricle and a serious defect called Hypoplastic Left Heart Syndrome.

  • Pulmonary Atresia: This is a malformation of the pulmonary valve that obstructs the outflow of blood from the right ventricle to the lungs. This can lead to underdevelopment of the right ventricle.

  • Hypoplastic Left Heart Syndrome with a restrictive atrial communication: This is an underdevelopment of the left ventricle of the heart that results in inadequate blood flow throughout the body. These babies need a hole between the upper chambers (atria) of the heart to allow blood to exit the lungs. If there is no hole or a very small hole between the upper chambers these babies can become severely ill after birth.
What happens if my baby is a candidate for a fetal intervention/surgery?
If your obstetrician or cardiologist thinks your baby's heart defect may benefit from a fetal intervention you should call the Advanced Fetal Care Center at Children's (617-355-3896). The AFCC will put you in touch with one of our cardiologists who will evaluate your situation. The cardiologist will speak to your obstetrician and cardiologist and, if possible, review your ultrasound study to determine if your baby is a candidate for a fetal intervention.
What are the different types of in utero fetal cardiac procedures?
There a three types of in utero fetal cardiac procedures:
  • In utero aortic valve dilation for severe aortic valve stenosis.
  • In utero dilation of the atrial septum for hypoplastic left heart syndrome with an intact or restrictive atrial septum.
  • In utero pulmonary valve dilation for pulmonary atresia.
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