Outcomes of prenatally diagnosed tetralogy of Fallot: Implications for valve-sparing repair versus transannular patch

Alim Hirji, Alessandra Bernasconi, Brian W. McCrindle, Elizabeth Dunn, Rebecca Gurofsky, Cedric Manlhiot, Steven E.S. Miner, John C.P. Kingdom, Edgar T. Jaeggi, Glen Van Arsdell, Lynne E. Nield

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: To assess outcomes of prenatally diagnosed tetralogy of Fallot and determine factors associated with the choice to undergo a valve-sparing repair versus transannular patch, and the use of prostaglandins at birth. METHODS: All cases at The Hospital for Sick Children (Toronto, Ontario) with a fetal diagnosis of tetralogy of Fallot from 1998 to 2006, were reviewed for demographic and fetal echocardiographic data to determine factors associated with the valve-sparing repair and need for perinatal support. RESULTS: Sixty-four fetuses met inclusion criteria (median gestational age 22 weeks) with 47 live births. Twenty-six underwent valve-sparing repair (median age 5.7 months) and 14 underwent transannular patch repair (median age 4.5 months). There were seven deaths before surgery and one post-transannular patch repair. One patient required a transannular patch repair after the initial valve-sparing repair. Twelve of 29 (41%) patients received prostaglandins at birth. Type of surgical repair, use of prostaglandins and postnatal death were among the outcomes investigated. The mean pulmonary valve (PV) z-score was -3.0±2.0 and the mean PV/aortic valve (AoV) ratio was 0.65±0.10. Lower PV z-score (P=0.04), smaller PV/AoV ratio (P=0.04) and the presence of nonantegrade arterial duct flow (P=0.02) were associated with prostaglandin use. A higher PV/AoV ratio was associated with valvesparing repair (P=0.04). Fetal z-scores of the PV, AoV and right pulmonary artery at 29 to 32 weeks gestational age correlated with respective postnatal z-scores (P=0.01). CONCLUSION: Fetal echocardiographic variables were associated with the use of prostaglandins and valve-sparing repair in fetuses with tetralogy of Fallot, and at 29 weeks, correlated with postnatal valve diameters.

Original languageEnglish (US)
Pages (from-to)e1-e6
JournalCanadian Journal of Cardiology
Volume26
Issue number1
DOIs
StatePublished - Jan 2010
Externally publishedYes

Keywords

  • Echocardiography
  • Fetal
  • Prenatal
  • Tetralogy of Fallot
  • Valve-sparing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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