Details

Autor(en) / Beteiligte

• Chiu, Joanne S
• Chelliah, Anjali
• Carroll, Sheila J
• Davey, Brooke
• Divanovic, Allison
• Hornberger, Lisa K
• Howley, Lisa W
• Kavanaugh-McHugh, Ann
• Kovalchin, John P
• Levasseur, Stephanie M
• Lindblade, Christopher L
• McCarter, Robert
• Moon-Grady, Anita J
• Morris, Shaine A
• Pruetz, Jay D
• Puchalski, Michael D
• Rychik, Jack
• Samai, Cyrus
• Schidlow, David
• Tacy, Theresa A
• Tworetzky, Wayne
• Vernon, Margaret M
• Yeh, Jay
• Donofrio, Mary T

Titel

Fetal Echocardiography Cardiac Doppler Predicts Outcomes in Tetralogy of Fallot with Absent Pulmonary Valve Syndrome

Ist Teil von

• Pediatric cardiology, 2016-08, Vol.37 (6), p.1192

Ort / Verlag

Springer

Erscheinungsjahr

2016

Link zum Volltext

Quelle

SpringerNature Journals

Beschreibungen/Notizen

• Objective: Tetralogy of Fallot with absent pulmonary valve (TOF/ APV) is a rare, severe heart defect. We hypothesized that fetal cardiac Doppler measurements may predict outcome. Methods: Fetal echocardiograms (FE) from 2002 to 2012 were compared in 99 subjects with TOF/APV from 18 centers among (1) subjects who died in utero versus live-born, and (2) subjects who died or required urgent surgery versus underwent elective repair. Nonparametric analysis compared Doppler median results using longitudinal quantile regression that accounted for the correlated repeat assessments. Results: Among 99 fetuses, there were 19 terminations, 30 deaths (6 in utero) and 50 alive at last follow-up. FE were analyzed in 80, with serial measurements available in 51. Subjects with fetal demise showed a decline in median left ventricular cardiac output (LVCO) from first to last FE (0.44-0.22 L/min) as compared to the group born alive which increased (0.36-0.69 L/min) (p = 0.02). Subjects who died prior to repair or underwent urgent surgery had increased pulmonary insufficiency (PI) velocity time integral (VTI) compared to those who had elective repair (29.3 vs. 22.2 cm) (p = 0.05). These patients also had an increase from first to last FE in PI VTI (22.5-30.9 cm) (p = 0.05) and PI end-diastolic velocity (95-115.3 cm/s) (p = 0.04). Conclusions: Doppler measures reflective of decreasing LVCO and worsening PI in fetuses with TOF/APV were predictive of death prior to repair and/or need for urgent surgery. These findings may help risk stratification and facilitate delivery planning.