more-in KOCHI: The use of technology to make medical interventions in the development of the heart of foetuses has had its share of uncertainties. But, for Gerald Tulzer and Wolfgang Arzt of Children’s Heart Centre at Kepler University, Linz, Austria, such scepticism is now perhaps a thing of the past. Johanna, the first child born with in-utero heart intervention at their centre, is now 17. Johanna did not have a full-fledged form in her mother’s womb when her parents, medical students at the time, approached the two doctors who were known to be working on foetal cardiology and foetal medicine. It was an opportunity for the doctors to understand how their theoretical knowledge and practical experiments could be applied to a real case. But, their first reaction was to say ‘no’ as they were unsure of the outcome. The expecting parents were told about the probability of saving the foetus, which had shown typical symptoms of a critical heart defect in the ultrasound scan. But, the couple insisted on getting the in-utero heart intervention, knowing fully well the pros and cons of the procedure. The result was a baby born with fully functional heart chambers. A follow-up treatment with balloon dilatation made Johanna a healthy baby. Today, 135 such interventions later, with over 80% success rate and no major risks to the mothers, the Children’s Heart Centre has become the institution to which foetuses with critical heart defects are referred to from all over Europe. “Only those cases that have already gone through a screening at the local level come to the centre. It is only after we see the images of the ultrasound of the foetal heart and other details provided by other centres that we decide on which case will have a good result,” said Dr. Tulzer. About 15-20% of the cases get rejected purely because they do not meet the criteria of survival and being born healthy. “The only criteria in picking up a case is the chance of survival of the foetus and being born with a healthy heart. Of course, the mother’s general health takes precedence. The only risk is that of anaesthesia as is the case of every surgery happening anywhere in the world,” said Dr. Arzt. The Linz centre has a multi-centric registry and the team involves experts in paediatric and foetal cardiology, foetal medicine, obstetrics, neonatology and paediatric cardiac surgery. The two experts were in the city leading the state-of-the-art Foetal Heart Workshop 2017, a part of Fetocon 2017 organized by the department of foetal medicine and foetal cardiology of the Amrita Institute of Medical Sciences. Balu Vaidyanathan, the organising chairman and director of foetal cardiology at the Amrita institute said the workshop focuses on latest breakthroughs and advancements in foetal therapy for various conditions in the intra-uterine stage and highlights the role of a comprehensive multidisciplinary team approach in achieving successful outcomes.

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