(soft music)
- I'm Dr. Carly Fifer.
I'm a pediatric cardiologist
at the University of Michigan.
I specialize in fetal cardiology.
Today, I'm gonna talk with you
about some of the indications
for fetal intervention in
babies with heart problems.
All babies with hypoplastic
left heart syndrome
are born with the left side
of the heart too small.
There's a very small
subset of these babies
that actually had a
normal-sized left heart
earlier in pregnancy.
These are the babies that
have critical aortic stenosis
when we see them in
the mid-term pregnancy.
In babies with critical aortic stenosis,
they have a normal left side of the heart,
but the aortic valve becomes very narrow
and the blood flow decreases
across the aortic valve.
In this diagram,
the valve we're talking about
is the aortic valve here,
which is leading blood from the
left ventricle out the body.
When this valve becomes very narrow
and very little blood
flow goes through it,
the pressure in the left
ventricle increases.
The left ventricle begins to dilate
and the function decreases, but over time,
it quits growing.
And if this continues through
the rest of the pregnancy,
by the time the baby's born,
the baby will have hypoplastic
left heart syndrome.
What we like to accomplish
with fetal intervention
on babies with critical aortic stenosis
is to open up the aortic valve
so that we can reestablish
normal blood flow
through the left side of the heart.
By doing this, we hope to
reestablish normal function
of the left ventricle
and normal growth of the left ventricle.
In this way, we feel that
some of these babies,
we may actually even prevent the formation
of hypoplastic left heart syndrome.
In other babies,
even though the left ventricle
may end up being small
still at birth,
we feel that they will
be much better candidates
for any surgical intervention
after the babies are born.
