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

Roland W. Weber, Ricardo Ayala-Arnez, Merna Atiyah, Yousef Etoom, Cedric Manlhiot, Brian W. McCrindle, Edward J. Hickey, Edgar T. Jaeggi, Lynne E. Nield

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)99-107
Number of pages9
JournalCardiology in the young
Volume23
Issue number1
DOIs
StatePublished - Feb 1 2013
Externally publishedYes

Keywords

  • Borderline hypoplastic left ventricle
  • coarctation of the aorta
  • foetal echocardiography
  • hypoplastic left heart syndrome
  • left ventricular outflow obstruction

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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