Fetal Heart Surgery - A Word About Mothers

Dateline: 05/10/98

The concept of treating diseases of the heart even when the "child" is in the womb - fetal intervention - is perhaps the most innovative advance in recent times.

In previous articles, we have discussed 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. After this, in a few articles, I focussed on some aspects of fetal heart surgery. This week, let's continue where I left off, and take a look at the mother's point of view. I thought this would be a nice topic for MOTHERS DAY anyway !

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 ....

THE MOTHER'S ROLE IN FETAL HEART SURGERY

What about the mother's role in fetal surgery ?

Though nothing is discussed about this aspect in most publications on fetal surgery experiments, it remains true that this novel technique is NOT entirely harmless to the mother. Physical and psychologic effects may occur that will alter the future reproductive life of the mother after an attempt at fetal intervention.

There is the physical stress and discomfort of multiple operations - first, to repair the heart defect in the fetus, later to extract the mature fetus by cesarean section. Coupled to this is the concern that these operations, by damaging the lining of the uterus, may even result in permanent sterility, preventing a future pregnancy. Weakening the wall of the womb also imposes the compulsion of a cesarean section in the event of any future pregnancy.

Apart from this, the mother has to face the psychological trauma of uncertainty about the outcome of the fetus. Definitely, fetal surgery will cause some tension, grief and struggle. Whether all moms will be able to, or indeed want to, undergo such a trial of strength remains a point to ponder.

Even if the outcome is successful, the long term survival of the fetus is not assured. Multiple procedures may yet be required. Costs involved have not yet been calculated definitely, but are likely to be considerable.

Many senior pediatric cardiologists, in discussing the therapeutic options available to women whose fetuses have complicated forms of congenital heart disease, unequivocally recommend termination of pregnancy, rather than attempting complex repairs. Though a debatable ethical issue, there is some logic in this suggestion from the point of view of the parent and family, who are forced to make a difficult decision.

How mothers will stand up to this new challenge will be known only in the future. But going by their track record, mom's sure will be able to meet it !

Happy Mother's Day to every one of you.

Next week : Women, Hormones and the Heart.