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Echocardiographic factors discriminating biventricular versus univentricular approach in the foetus with borderline left ventricle

Published online by Cambridge University Press:  13 August 2014

David W. Jantzen ,
Sarah K. Gelehrter ,
Sunkyung Yu ,
Janet E. Donohue  and
Carlen G. Fifer
David W. Jantzen*
Affiliation:
University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, Michigan, United States of America
Sarah K. Gelehrter
Affiliation:
University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, Michigan, United States of America
Sunkyung Yu
Affiliation:
University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, Michigan, United States of America
Janet E. Donohue
Affiliation:
University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, Michigan, United States of America
Carlen G. Fifer
Affiliation:
University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, Michigan, United States of America
*
Correspondence to: D. W. Jantzen, MD, University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, 1540 East Hospital Drive, Ann Arbor, MI 48109, United States of America. Tel: 734 764 5177; Fax: 734 936 9470; E-mail: [email protected]
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Abstract

Background: The term “borderline left ventricle” describes a small left heart that may be inadequate to provide systemic cardiac output and implies the potential need for a single-ventricle palliation. The aim of this study was to identify foetal echocardiographic features that help discriminate which infants will undergo single-ventricle palliation versus biventricular repair to aid in prenatal counselling. Methods: The foetal database at our institution was searched to identify all foetuses with borderline left ventricle, as determined subjectively by a foetal cardiologist, from 2000 to 2011. The foetal images were retrospectively analysed for morphologic and physiologic features to determine which best predicted the postnatal surgical choice. Results: Of 39 foetuses identified with borderline left ventricle, 15 were planned for a univentricular approach, and 24 were planned for a biventricular approach. There were significant differences between the two outcome groups in the Z-scores of the mitral valve annulus, left ventricular end-diastolic dimension, aortic valve annulus, and ascending aorta diameter (p<0.05). With respect to discriminating univentricular outcomes, cut-offs of mitral valve Z-score ⩽−1.9 and tricuspid:mitral valve ratio ⩾1.5 were extremely sensitive (100%), whereas a right:left ventricular end-diastolic dimension ratio ⩾2.1 provided the highest specificity (95.8%). Conclusion: In foetuses with borderline left ventricle, a mitral valve Z-score ⩾−1.9 or a tricuspid:mitral valve ratio ⩽1.5 suggests a high probability of biventricular repair, whereas a right:left ventricular end-diastolic dimension ratio ⩾2.1 confers a likelihood of single-ventricle palliation.

Keywords

Foetal echocardiogramborderline left ventriclehypoplastic left heartCHD
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 5 , June 2015 , pp. 941 - 950
Copyright
© Cambridge University Press 2014 

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