Rainbow Children’s Heart Institute Pioneers Life-Saving Treatment for Immune-Mediated Fetal Myocarditis, Offering New Hope to High-Risk Pregnancies
In a landmark medical achievement that could redefine prenatal care for rare cardiac conditions, Rainbow Children’s Heart Institute in Hyderabad has become one of the first centers in the world to successfully perform direct fetal immunotherapy delivering targeted treatment straight to the unborn baby to combat immune-mediated fetal myocarditis and related heart block.
The breakthrough, detailed in a recent publication in JACC: Case Reports, involved five fetuses diagnosed between 21 and 27 weeks of gestation with severe, rapidly progressing heart disease caused by maternal autoantibodies. All five showed remarkable recovery after treatment, with improved heart function, reduced fluid buildup (hydrops), stabilized rhythms, and successful full-term deliveries
A Race Against Time in the Womb
The story begins with a 29-year-old mother living with Sjögren’s syndrome, an autoimmune disorder. She had previously lost a pregnancy. At 22 weeks, fetal echocardiography uncovered a dire situation: immune-mediated cardiomyopathy, second-degree heart block, a dangerously slow fetal heart rate, and weakening cardiac pumping. Maternal antibodies had crossed the placenta, attacking the developing heart and threatening heart failure or fetal death.
Traditional approaches treating the mother with medications like steroids often fall short in urgent cases, as the therapy may not reach the fetus quickly or in sufficient strength. The institute’s multidisciplinary team, led by experts in pediatric cardiology and fetal medicine, opted for a bold, precise intervention: direct intraperitoneal immunoglobulin (IPIG) administered to the fetus under advanced ultrasound guidance.
The results were dramatic. Post-intervention, the fetal heart rate normalized to a healthy 150 beats per minute, contractility recovered, and the threat of progression reversed. The baby was born at term with a normal heart rhythm and has remained stable.
“This is not routine care it’s reserved for the most severe cases where standard maternal treatment isn’t enough and the risk to the baby is extreme,” explains Dr. Bhargavi Dhulipudi, Pediatric Cardiologist at Rainbow Children’s Heart Institute. “Direct fetal immunotherapy requires cutting-edge imaging, pinpoint accuracy, and seamless teamwork, but it can be a game-changer when options are limited.”
Beyond One Case: A Series of Successes
The published case series in JACC: Case Reports (Bakhru S, Dhulipudi B, Koneti NR. Fetal Intraperitoneal Immunoglobulin for Autoimmune Myocarditis and AV Block: First Clinical Experience in 5 Fetuses. 2025) highlights consistent outcomes across the five treated fetuses
Rapid resolution of hydrops and regression of endocardial fibroelastosis
Enhanced myocardial performance
Normalization or improvement in life-threatening rhythm issues (like AV block)
All babies delivered alive, with reassuring heart function on follow-up
Dr. Shweta Bakhru, another key Pediatric Cardiologist involved, notes the stealthy nature of the disease: “Mothers often have no symptoms, so the condition is detected late and can worsen quickly. Treating only the mother may not act fast enough. Direct delivery to the fetus targets the damage more effectively and can alter the outcome.”
Dr. Nageswara Rao Koneti, Senior Pediatric Cardiologist, underscores the global significance: “Very few centers worldwide have experience with this level of in-utero intervention for immune-related fetal heart disease. It shows how targeted, imaging-guided treatment can stabilize rapidly deteriorating conditions and open doors for babies who once faced grim odds.”
A Beacon of Hope for Rare Prenatal Conditions
These early successes signal a promising shift in managing high-risk immune-mediated fetal heart diseases. While not applicable to every case, the approach expands possibilities in specialized centers equipped for advanced fetal procedures.
Rainbow Children’s Heart Institute, an exclusive pediatric cardiac center backed by the renowned Rainbow Children’s Hospitals, continues to lead in innovative care for congenital and acquired heart issues in children and now, in the womb.
For families facing similar rare prenatal cardiac challenges, this breakthrough represents renewed hope: timely, precise intervention can turn potential tragedy into healthy beginnings.
Published in JACC: Case Reports under open access (CC BY-NC-ND license). For more information on Rainbow Children’s Heart Institute.
