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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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References

1. Corno, AF. Borderline left ventricle. Eur J Cardiothorac Surg 2005; 27: 67–73.CrossRefGoogle ScholarPubMed
2. Hickey, EJ, Caldarone, CA, Blackstone, EH, et al. Critical left ventricular outflow tract obstruction: the disproportionate impact of biventricular repair in borderline cases. J Thorac Cardiovasc Surg 2007; 134: 1429–1436; discussion 36–37.Google Scholar
3. Lofland, GK, McCrindle, BW, Williams, WG, et al. Critical aortic stenosis in the neonate: a multi-institutional study of management, outcomes, and risk factors. Congenital Heart Surgeons Society. J Thorac Cardiovasc Surg 2001; 121: 10–27.Google Scholar
4. Rhodes, LA, Colan, SD, Perry, SB, Jonas, RA, Sanders, SP. Predictors of survival in neonates with critical aortic stenosis. Circulation 1991; 84: 2325–2335.CrossRefGoogle ScholarPubMed
5. Colan, SD, McElhinney, DB, Crawford, EC, Keane, JF, Lock, JE. Validation and re-evaluation of a discriminant model predicting anatomic suitability for biventricular repair in neonates with aortic stenosis. J Am Coll Cardiol 2006; 47: 1858–1865.Google Scholar
6. Tani, LY, Minich, LL, Pagotto, LT, Shaddy, RE, McGough, EC, Hawkins, JA. Left heart hypoplasia and neonatal aortic arch obstruction: is the Rhodes left ventricular adequacy score applicable? J Thorac Cardiovasc Surg 1999; 118: 81–86.Google Scholar
7. Alboliras, ET, Mavroudis, C, Pahl, E, Gidding, SS, Backer, CL, Rocchini, AP. Left ventricular growth in selected hypoplastic left ventricles: outcome after repair of coarctation of aorta. Ann Thorac Surg 1999; 68: 549–555.Google Scholar
8. Peterson, RE, Levi, DS, Williams, RJ, Lai, WW, Sklansky, MS, Drant, S. Echocardiographic predictors of outcome in fetuses with pulmonary atresia with intact ventricular septum. J Am Soc Echocardiogr 2006; 19: 1393–1400.Google Scholar
9. Roman, KS, Fouron, JC, Nii, M, Smallhorn, JF, Chaturvedi, R, Jaeggi, ET. Determinants of outcome in fetal pulmonary valve stenosis or atresia with intact ventricular septum. Am J Cardiol 2007; 99: 699–703.Google Scholar
10. Salvin, JW, McElhinney, DB, Colan, SD, et al. Fetal tricuspid valve size and growth as predictors of outcome in pulmonary atresia with intact ventricular septum. Pediatrics 2006; 118: e415–e420.Google Scholar
11. Makikallio, K, McElhinney, DB, Levine, JC, et al. Fetal aortic valve stenosis and the evolution of hypoplastic left heart syndrome: patient selection for fetal intervention. Circulation 2006; 113: 1401–1405.CrossRefGoogle ScholarPubMed
12. McElhinney, DB, Marshall, AC, Wilkins-Haug, LE, et al. Predictors of technical success and postnatal biventricular outcome after in utero aortic valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome. Circulation 2009; 120: 1482–1490.Google Scholar
13. Pitkanen, OM, Hornberger, LK, Miner, SE, et al. Borderline left ventricles in prenatally diagnosed atrioventricular septal defect or double outlet right ventricle: echocardiographic predictors of biventricular repair. Am Heart J 2006; 152: 163 e1–e7.Google Scholar
14. Weber, RW, Ayala-Arnez, R, Atiyah, M, Etoom, Y, et al. Foetal echocardiographic assessment of borderline small left ventricles can predict the need for postnatal intervention. Cardiol Young 2012; 23: 1–9.Google Scholar
15. Tchervenkov, CI, Tahta, SA, Jutras, LC, Beland, MJ. Biventricular repair in neonates with hypoplastic left heart complex. Ann Thorac Surg 1998; 66: 1350–1357.CrossRefGoogle ScholarPubMed
16. Schwartz, ML, Gauvreau, K, Geva, T. Predictors of outcome of biventricular repair in infants with multiple left heart obstructive lesions. Circulation 2001; 104: 682–687.Google Scholar
17. Quartermain, MD, Cohen, MS, Dominguez, TE, Tian, Z, Donaghue, DD, Rychik, J. Left ventricle to right ventricle size discrepancy in the fetus: the presence of critical congenital heart disease can be reliably predicted. J Am Soc Echocardiogr 2009; 22: 1296–1301.Google Scholar
18. Davis, CK, Pastuszko, P, Lamberti, J, Moore, J, Hanley, F, El Said, H. The hybrid procedure for the borderline left ventricle. Cardiol Young 2011; 21: 26–30.Google Scholar
19. Emani, SM, McElhinney, DB, Tworetzky, W, et al. Staged left ventricular recruitment after single-ventricle palliation in patients with borderline left heart hypoplasia. J Am Coll Cardiol 2012; 60: 1966–1974.Google Scholar