In the 1960s, intrauterine fetal transfusion therapy opened the door to intrauterine fetal treatment. With the increasing accuracy of human fetal cardiac ultrasound diagnosis and the development of fetal surgery, intrauterine intervention for complex cardiac malformations was envisioned to improve the salvage of complex precardial diseases. Starting from the 1980s, foreign scholars conducted research on extracorporeal circulation in animal fetuses to prepare the technology for fetal heart surgery. However, extracorporeal circulation in animal fetuses severely affects placental function, making it difficult for animal fetuses to survive delivery. Improving the technique of extracorporeal circulation, narrowing the extracorporeal circulation duct, and suppressing the stress response have resulted in a full-term survival rate of over 80% in fetal sheep after extracorporeal circulation. However, primate fetuses do not survive extracorporeal circulation, and recent studies have shown that extracorporeal circulation in fetal lambs directly affects fetal cardiac function, so current fetal extracorporeal circulation techniques are not yet clinically available, hindering the development of fetal cardiac surgery. Fetal cardiac interventions have been performed clinically as early as the 1990s. The aim is to improve fetal intrauterine survival and promote biventricular development. The technical success rate of the initial 12 fetal cardiac interventions internationally was approximately 60%, with only one surviving fetus achieving biventricular development. Foreign scholars have recognized that patient selection, obstetric and anesthetic management strategies, well-trained surgical procedures, pre-treatment of high-risk factors, and good equipment are critical to the success of fetal cardiac interventions. Further correction of cardiac anomalies after birth and aggressive management in the intensive care unit are also important aspects of the eventual cure of the child. Experience with large volume fetal cardiac interventions comes from a multidisciplinary team at Boston Children’s Hospital in the United States, which used ultrasound-guided direct cardiac puncture access and aortic balloon angioplasty to relieve fetal aortic stenosis and avoid further progression of left heart dysplasia, with a technical success rate of more than 80% and the ability to correct biventricular correction in about 1/4 of fetuses after birth. Balloon dilation or stenting of the foramen ovale in fetuses with left heart dysplasia was performed to alleviate the effects of restrictive foramen ovale on fetal survival and to avoid fetal lung congestion, contributing to improved survival in Norwood stage 1. In Europe, the Children’s Hospital of Linz, Austria, reported that a group of fetuses with severe aortic stenosis undergoing aortic balloon valvuloplasty achieved technical success in 2/3 of the fetuses, of which 2/3 in turn achieved a postnatal biventricular circulation pattern, while the others developed left heart dysplasia. This indicates that fetal cardiac interventions can save a proportion of fetuses with complex precardiac disease from progressing to a biventricular circulatory pattern, and that fetal cardiac interventions require strict indications and close follow-up. Fetal surgery is continuing to evolve into a minimally invasive field. Minimally invasive techniques are being attempted in fetal cardiac interventions, such as fetal esophageal ultrasound placed under fetoscopy, which allows high-frequency images of the fetal heart independent of images of the fetal heart through the maternal abdominal wall, and electrocardiography, which allows for more accurate assessment of fetal cardiac rhythm and its modulation. Thomas Kohl, a German fetal surgeon, has gained experience in fetal heart surgery by obtaining the consent of the pregnant woman to attempt a fetoscopic approach to expose the heart through the glabella on the body of the induced fetus. The combination of lumpectomy and interventional techniques is one of the current models of mosaic treatment of precardiac disease that could be implemented in the future in the intervention of structural malformations of the fetal heart. In addition to these techniques, intermittent maternal oxygenation may be an active intervention for fetal cardiac malformations. Maternal oxygen in late gestation significantly dilates the fetal pulmonary vasculature, increasing pulmonary circulation and return flow to and from the body circulation, and maintaining this physiological feature can promote further development of the heart in a subset of fetuses with ventricular dysplasia. A small amount of clinical data has been available to support this treatment, and future randomized clinical studies are needed to evaluate the feasibility of this treatment.