Prenatal assessment of Tetralogy of Fallot: A multicenter prospective cohort study

Deborah S. Fruitman, Valerie Bloomfield, Brigitte Mueller, Hilary Kwok, Cedric Manlhiot, Lynne E. Nield

Research output: Contribution to journalArticlepeer-review


Predicting clinical outcomes in prenatally diagnosed Tetralogy of Fallot remains a challenge. This multicenter study aimed to prospectively evaluate fetal echocardiographic parameters associated with early neonatal intervention (<60 days). Secondary outcomes included oxygen saturation <80% at delivery, prostaglandin need, and valve sparing vs transannular patch repair. Serial fetal echocardiographic measurements were obtained. Patients were followed through pregnancy until 12 months post-surgical correction. Stepwise selection of variables was performed to identify important associated risk factors. Binomial logistic regression was used to analyze the primary and secondary outcomes. Between 2009 and 2014, N = 54/79 were recruited at 24 weeks gestational age (range 21–29 weeks), 2 died in utero and 3 died postnatally. The pulmonary valve z-score was smaller in patients who underwent early intervention (−3.4 ± 1.1 vs. −2.5 ± 1.8; p =.044) and smaller pulmonary valve z score was associated with transannular patch (Odd ratio (OR) 1.9; CI 1.2–3.1; p =.008). Reversal of flow in the ductus arteriosus was associated with early intervention (OR 6.6; CI 1.4–38.3; p =.023). Patients with an underlying genetic syndrome were more likely to undergo early intervention (11/15 (73%) vs 7/36 (23%), p =.001). In conclusion, for this prospective cohort, reversed flow in the ductus arteriosus was the only factor significantly associated with early intervention with a lower pulmonary valve z-score being associated with transannular patch repair. Patients with a genetic syndrome were more likely to undergo an early intervention.

Original languageEnglish (US)
Article number101279
JournalProgress in Pediatric Cardiology
StatePublished - Mar 2021
Externally publishedYes


  • Early intervention
  • Fetal echocardiography
  • Predictors of outcome
  • Tetralogy of Fallot

ASJC Scopus subject areas

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


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