Fetal Heart Surgery - Why not simply terminate pregnancy ?

Dateline: 03/22/98

With the explosion of technology in cardiac surgery, it is difficult to point to one development and say "This is it, THIS is the most innovative advance in recent times". Over the past month, we have discussed the concept of minimally invasive heart surgery, and the use of this novel technique in treating coronary artery disease , heart valve disease and birth defects of the heart. For more information on minimally invasive surgery, visit the MICAS website. However, the concept of treating diseases of the heart even when the "child" is in the womb - fetal intervention - is perhaps the nearest to "IT".

Fetal Heart Surgery is an idea which has totally captured my imagination. It has strong detractors as well. So I thought of starting a forum to discuss this contentious issue. Many, many issues are involved. I will discuss some of them here. It would be nice if you could suggest others as well. You can post your comments on the Bulletin Board.

This week, the issue is ....

WHY NOT SIMPLY TERMINATE THE COMPLEX PREGNANCY ?

Medical Termination of Pregnancy (MTP) is, has been, and will continue to be, a very controversial issue. Moral, ethical, religious, scientific and intensely emotional arguments can be made for and against MTP.

I will not enter into this controversy....simply list the points in favor of the procedure, and those against it, in complicated pregnancies.

As I have tried to emphasize in all the other articles, fetal heart surgery as things stand today, is a highly uncertain experimental intervention. No one can definitely say which kind of defect is going to be reliably corrected by this technique. Personally, I believe it is here to stay, and with time it will develop enough to be safely recommended as an option. Maybe then this article will have to be rewritten.

AS THINGS STAND TODAY, however, MTP would still be considered an alternative to fetal heart surgery - perhaps a safer, less expensive alternative.

This reasoning is based on the following facts:

• There is no uncertainty involved about outcome of this particular fetus.

• The risk of crippling complications to the fetus, or the need for later sequential surgical procedures is abolished.

• The risks to the mother are much less if termination is chosen early on.

• Psychologically the stress, though intense at the time, would not be spread out over a prolonged period, as would be the case with fetal intervention.

• It could indeed be cheaper; it could save a family considerable expense, grief, and struggle.

Against this could be stacked the fact that this particular pregnancy may be a "precious" one, attained after many years of infertility. Strong emotional or religious beliefs against MTP may be another factor.

The decision however will have to be made by both physician and parent after fully analyzing the issues. Like all similar decisions, any choice will necessarily be painful.

The ray of hope on the horizon is that maybe we are not far away from the days when genetic manipulation will be possible. This would be much safer, and more certain in abolishing birth defects of the heart...and much human sufferring and agony on the part of the parent and health-provider.

Next week : Which diseases deserve fetal surgery ?