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Foetal echocardiographic assessment of borderline small left ventricles can predict the need for postnatal intervention

Published online by Cambridge University Press:  05 April 2012

Roland W. Weber ,
Ricardo Ayala-Arnez ,
Merna Atiyah ,
Yousef Etoom ,
Cedric Manlhiot ,
Brian W. McCrindle ,
Edward J. Hickey ,
Edgar T. Jaeggi  and
Lynne E. Nield
Roland W. Weber
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, Toronto, Ontario, Canada Division of Cardiology, University Children's Hospital, University of Zurich, Zurich, Switzerland
Ricardo Ayala-Arnez
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, Toronto, Ontario, Canada
Merna Atiyah
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, Toronto, Ontario, Canada
Yousef Etoom
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, Toronto, Ontario, Canada
Cedric Manlhiot
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, Toronto, Ontario, Canada
Brian W. McCrindle
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, Toronto, Ontario, Canada
Edward J. Hickey
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, Toronto, Ontario, Canada
Edgar T. Jaeggi
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, Toronto, Ontario, Canada
Lynne E. Nield*
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, Toronto, Ontario, Canada
*
Correspondence to: Dr L. E. Nield, MD, The Hospital for Sick Children, Labatt Family Heart Centre, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. Tel: +1 416 813 6141; Fax: +1 416 813 5857; E-mail: [email protected]
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Abstract

Background

We sought to prospectively determine foetal echocardiographic factors associated with neonatal interventions in borderline hypoplastic left ventricles.

Methods

Foetuses were included who had a left ventricle that was 2–4 standard deviations below normal for length or diameter and had forward flow across the mitral and aortic valves. Factors associated with an intervention in the first month of life or no need for intervention were sought using univariate and multivariate logistic regression models.

Results

From 2005 to 2008, 47 foetuses meeting the criteria had an additional diagnosis (+foetal coarctation/+transverse arch hypoplasia): atrioventricular septal defect 7 (+2/+0), double outlet right ventricle 2 (+0/+0), Shone's complex 19 (+9/+4), and ventricular disproportion 19 (+13/+11; 4 both). There were seven pregnancies terminated, three foetal demises, and five had compassionate care. There were 32 livebirths that either had a biventricular repair (n = 20, n = 2 dead), univentricular palliation (n = 2, both alive), or no intervention (n = 9). Overall survival of livebirths to 6 months of age was 79%. Factors associated with early intervention on first foetal echocardiogram were: obstructed or retrograde arch flow (p = 0.08, odds ratio 3.3), coarctation (p = 0.05, odds ratio 11.4), and left ventricle outflow obstruction (p = 0.05, odds ratio 12.5). Neonatal factors included: Shone's diagnosis (p = 0.02, odds ratio 4.9), bicuspid aortic valve (p = 0.005, odds ratio 11.7), and larger tricuspid valve z-score (p = 0.05, odds ratio 3.6). A neonatal factor associated with no intervention was a larger mitral valve z-score (mean −3.8 versus −4.2 intervention group, p = 0.04, odds ratio 2.8).

Discussion

The need for early intervention in foetuses with borderline hypoplastic left ventricle can be predicted by foetal echocardiography.

Keywords

Borderline hypoplastic left ventriclecoarctation of the aortafoetal echocardiographyhypoplastic left heart syndromeleft ventricular outflow obstruction
Type
Original Article
Information
Cardiology in the Young , Volume 23 , Issue 1 , February 2013 , pp. 99 - 107
Copyright
Copyright © Cambridge University Press 2012

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