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Infants born with a rare heart defect may have better outcomes when surgery to repair the heart is done while the infant is still in the womb, Harvard University researchers say.

The condition, hypoplastic left heart syndrome, occurs when the fetus’s left ventricle is underdeveloped and the heart cannot pump enough blood to sustain life. It affects about 1 in 10,000 newborns, and without open-heart surgery within a week of birth, these infants face death. Even with the heart repair, the children lead restricted lives and need at least one heart transplant, researchers say.

“Using the new procedure, in about 30 percent of the fetuses [with technically successful operations], there was an outcome of a two-ventricle circulation after birth,” said Dr. Doff B. McElhinney, an assistant professor of pediatrics at Harvard Medical School and an associate in cardiology at Children’s Hospital Boston.

The findings appear online Sept. 28 in Circulation.

How well the infants in the study will fare over the long term isn’t known, but the researchers intend to follow them as they grow up, McElhinney said.

In fetuses, aortic stenosis usually progresses to hypoplastic left heart syndrome, the study explains. Prenatal intervention could reduce the total number of surgeries required over a lifetime, eliminate the need for a heart transplant and possibly improve the children’s quality of life, he said.

According to the study, 51 of 68 procedures were considered technically successful, and 17 infants (33 percent of the 51) were born with a fully functioning heart.

The operation involves threading a catheter through the mother’s abdomen into the fetus’s heart. A balloon at the end of the catheter enlarges the aortic valve that controls blood flow from the left ventricle into the aorta and then into the body, McElhinney explained.

Over seven years, the researchers were able to establish criteria to determine which infants were likely to benefit from the procedure, which would not and when the operation would be most likely to succeed, McElhinney said. “This enables us to focus it more, and expose fewer mothers and fetuses to the risks of the procedure,” he said.

The window for performing the procedure is narrow — at around 20 to 21 weeks of pregnancy, McElhinney said. With time, experience and better technology, the success rate will get better, he added.

McElhinney is cautious about the impact of the new procedure and doesn’t want to oversell its benefits.

“By no means is this revolutionizing the care for all fetuses with hypoplastic left heart syndrome,” he said. “It’s applicable only in a small subset of those with this disease, and it’s working in a relatively small percentage of those in whom we attempt it,” he said. And even infants who had a successful procedure needed additional procedures after birth, he noted.

Still, while not a “ringing success,” he said it reinforces the belief that prenatal intervention can be used to change the development of serious forms of heart disease.

Dr. Steven E. Lipshultz, chairman of pediatrics at the Leonard M. Miller School of Medicine at the University of Miami, said that the study points the way to better treatment and outcomes for youngsters with this heart problem.

“This is a landmark study,” Lipshultz said. Without this procedure, “every one of these kids would have needed open heart surgery in the first few days after birth,” he said. Additional surgeries and multiple heart transplants are almost always necessary, he added.

Parents whose doctors think their baby might have hypoplastic left heart syndrome should act fast to find a program that will consider their child for a fetal operation, he said.

Dr. Ruben A. Quintero, professor and director of maternal-fetal medicine at the Miller School of Medicine, said he thinks that much more needs to be done to improve the procedure and increase the success rate before embracing the operation.

“What needs to happen now is that other centers use the experience of the Boston group to share their outcomes and try to improve on the limitations that the Boston group has outlined,” he said. “This has happened in other areas of fetal therapy.”

Once the surgical technique is ironed out, clinical trials should compare the outcomes of those undergoing the procedure with those who don’t have it, Quintero said.

Just one of every eight strokes is preceded by a milder interruption of blood flow to the brain, called a transient ischemic attack (TIA), a new Canadian study shows.

And because of that, the researchers conclude, such an attack is not the crucial warning sign that physicians need.

“The clinical implication of this study is that we cannot rely on the TIA as a warning signal to tell us to intervene to prevent a stroke because it is seen before only one of every eight strokes,” said Dr. Daniel G. Hackam, an assistant professor of medicine in neurology at the University of Western Ontario in Canada and lead author of a report in the Sept. 29 issue of Neurology.

“We need better risk profiles to predict a patient who will have that first stroke,” Hackam said. “This study is highlighting a gap in our knowledge base. If we know a stroke is impending, we can intervene to prevent that stroke.”

In the study, Hackam and his colleagues found that, of the 16,409 people diagnosed with stroke over a four-year period in Ontario hospitals, 2,032 — or 12.4 percent of them — had a TIA in the weeks before the stroke.

A TIA, he said, does not have enough predictive power to warrant intensive preventive measures.

“We need better tools,” Hackam said. “That is really the main message of our paper.”

A TIA, which some refer to as a mini-stroke, occurs when a clot briefly blocks a brain artery. Symptoms of a TIA are the same as those of a stroke — sudden onset of weakness or numbness in an arm or leg, loss of vision or double vision, speech difficulty, dizziness, loss of balance — but they go away, often in a few minutes. Many people ignore the symptoms, but they are clear signs of possible trouble, Hackam said.

The numbers in the new study are similar to those about TIA and subsequent stroke that have been reported for decades, said Dr. Larry B. Goldstein, director of the Duke Stroke Center. But he disagrees with Hackam’s interpretation of the predictive importance of TIAs.

“They predict 10 to 15 percent of strokes,” Goldstein said. “This is not a small number, so it is an opportunity to prevent stroke that you don’t want to miss when it happens.”

Better predictive tools are available, Hackam said. He prefers carotid ultrasound, an inexpensive way to listen to blood flow in the main artery to the brain. “It’s fairly inexpensive, and I do it for everyone I see in the clinic,” Hackam noted.

His patients have been referred to the stroke clinic because they have the risk factors for stroke, which include old age, smoking, high blood pressure, obesity and high cholesterol, Hackam said. Results of a carotid ultrasound test can confirm the need for treatment not only with medications to control blood pressure and blood fats but also with lifestyle changes such as more exercise, no smoking and a less-fatty diet, Hackam said.

Goldstein, though, said that detailed tests such as carotid ultrasound are not needed to recommend such measures for people who have the risk factors for stroke. Those tests tend to measure not the specific risk of stroke but the risk of all cardiovascular problems, including heart attacks, he said.

“The more tests you do, the more chance there is to make a mistake,” Goldstein said. “The standard risk factors can lead to recommending basic lifestyle changes. People who don’t smoke, who drink moderately, who keep their blood pressure low, are less likely to have strokes.”

And anyone who experiences a TIA should report it to a doctor immediately, Goldstein said. “It only matters if you are going to do something about it,” he said. “A TIA identifies someone who is at high risk of having a stroke in a short period of time.”

Wealthy people are twice as likely to suffer retinal detachment as poorer people, according to Scottish researchers who said they couldn’t identify the reason for the disparity.

Retinal detachment — the separation of the retina from its connection at the back of the eye — usually occurs as a result of a tear in the retina. If patients don’t receive immediate treatment, retinal detachment can lead to permanent vision loss.

The new study included 572 patients diagnosed with primary retinal detachment in Scotland over a one-year period between 2007 and 2008. The rate of retinal detachment was 15.4 per 100,000 population among the most affluent patients, compared with 13.6 per 100,000 for the second-most affluent patients, 9.3 per 100,000 for the third-most affluent patients, and 6.9 per 100,000 among the least affluent patients.

This was a surprising finding that’s never been reported before, said Dr. David Yorston of Gartnavel General Hospital in Glasgow, and colleagues.

“We have not found any satisfactory explanation for the greater incidence of [retinal detachment] in less deprived patients. It is possible that a combination of small differences in known risk factors, such as myopia [short-sightedness] and previous cataract surgery account for the difference,” they wrote. “However, we cannot exclude the possibility that affluence is associated with some other, hitherto, unknown risk factor.”