Fetal Echocardiographic Parameters and Surgical Outcomes in Congenital Left-Sided Cardiac Lesions

• Published in: Pediatric cardiology 2019-08, Vol.40 (6), p.1304-1313
• Main Authors: Edwards, Lindsay A., Arunamata, Alisa, Maskatia, Shiraz A., Quirin, Amy, Bhombal, Shazia, Maeda, Katsuhide, Tacy, Theresa A., Punn, Rajesh
• Format: Article
• Language: English
• Subjects: Cardiac Surgery; Cardiology; Congenital heart disease; Genetic disorders; Heart; Infants (Newborn); Medicine; Medicine & Public Health; Neonatology; Original Article; Vascular Surgery
• ISSN: 0172-0643; 1432-1971
• DOI: 10.1007/s00246-019-02155-7

This study aimed to evaluate fetal echocardiographic parameters associated with neonatal intervention and single-ventricle palliation (SVP) in fetuses with suspected left-sided cardiac lesions. Initial fetal echocardiograms (1/2002–1/2017) were interpreted by the contemporary fetal cardiologist as coarctation of the aorta (COA), left heart hypoplasia (LHH), hypoplastic left heart syndrome (HLHS), mitral valve hypoplasia (MVH) ± stenosis, and aortic valve hypoplasia ± stenosis (AS). The cohort comprised 68 fetuses with suspected left-sided cardiac lesions (COA n  = 15, LHH n  = 9, HLHS n  = 39, MVH n  = 1, and AS n  = 4). Smaller left ventricular (LV) length Z score, aortic valve Z score, ascending aorta Z score, and aorta/pulmonary artery ratio; left-to-right shunting at the foramen ovale; and retrograde flow in the aortic arch were associated with the need for neonatal intervention ( p  = 0.005–0.04). Smaller mitral valve (MV) Z score, LV length Z score, aortic valve Z score, ascending aorta Z score, aorta/pulmonary artery ratio, and LV ejection fraction, as well as higher tricuspid valve-to-MV (TV/MV) ratio, right ventricular-to-LV (RV/LV) length ratio, left-to-right shunting at the foramen ovale, abnormal pulmonary vein Doppler, absence of prograde aortic flow, and retrograde flow in the aortic arch were associated with SVP ( p   1.28 was associated with SVP with a sensitivity of 76% and specificity of 96% (AUC 0.90, p   1.28 may be a useful threshold for identifying fetuses requiring SVP.