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Fetal Cardiology: Early Intervention Alters Course of Heart Defects

Aimee K. Armstrong, MD, director of Cardiac Catheterization and Interventional Therapies on the Fetal Cardiac Team at Nationwide Children’s Hospital, has performed fetal heart procedures more than a dozen times in her career.

“By performing interventions on the fetal heart, we are able to alter the trajectory of heart and lung disease development before a baby is born, with the goal of making the baby’s heart healthier at birth,” Dr. Armstrong says. “We ultimately hope to be able to decrease morbidity and mortality for these babies.”

She is a leader of the Fetal Cardiac Program, which provides in utero diagnosis and treatment for a number of congenital defects including critical aortic stenosis, hypoplastic left heart syndrome (HLHS) and pulmonary atresia.

Since arriving at Nationwide Children’s in 2015, Dr. Armstrong has built a fetal heart intervention team of experts from Nationwide Children’s, University Hospital’s Rainbow Babies & Children’s Hospital and University Hospitals MacDonald Women's Hospital, as part of the Congenital Heart Collaborative. The collaborative is designed to provide a continuum of care for patients with congenital heart disease from fetus to adulthood.

"We are able to alter the trajectory of heart and lung disease development before a baby is born."
– Aimee K. Armstrong, MD

The collaborative is the only Ohio program to offer fetal aortic valvuloplasty. The team has performed four of the procedures in just over a year. The first was on a boy at 24 weeks of gestation at UH Rainbow with HLHS and severe leakage of another heart valve. Statistics suggest he had a 10% chance of survival to 6 months of age.

“When I first met the family, their goal was to have a few hours to hold him before he passed away,” says James Strainic, MD, director, Fetal Heart Program at UH Rainbow.

The boy was born full-term in June and discharged with his mother four days later.

“The procedure completely reversed the evolving HLHS, in addition to the severe valve leakage to the point that an open heart surgery may never be needed, which is the best possible outcome for him.”

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