Fetal Left Heart Obstructive Lesions: Aortic Stenosis, Shone’s Complex, and Aortic Arch Obstruction

This chapter explores left-sided obstructive lesions in the fetus. This includes discussion of aortic stenosis, primarily discussing valvar stenosis with brief coverage of supravalvar aortic stenosis as well. Within this section, critical aortic stenosis and mitral valve dysplasia are discussed. The chapter goes on to include coarctation of the aorta, Shone’s complex, and interrupted aortic arch. Within each section, we review manifestation of the lesion in obstetric ultrasound, history taking with the role of prenatal genetic testing for specific lesions as well as the role of additional testing for risk stratification and prognostication, details of fetal echocardiography, fetal life follow-up and what to expect during the remainder of the gestation, fetal interventions (if there are any), and expected changes in hemodynamics at birth with recommendations for preparation at delivery and the immediate postnatal course.