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Erschienen in: Pediatric Cardiology 5/2014

01.06.2014 | Original Article

Fetal Echocardiographic Measurements and the Need for Neonatal Surgical Intervention in Tetralogy of Fallot

verfasst von: Bhawna Arya, Stéphanie M. Levasseur, Kristal Woldu, Julie S. Glickstein, Howard F. Andrews, Ismée A. Williams

Erschienen in: Pediatric Cardiology | Ausgabe 5/2014

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Abstract

Background

This study aimed to evaluate fetal echocardiographic measurements at the time of the first fetal echocardiogram as predictors of neonatal outcome for tetralogy of Fallot (TOF).

Methods

The study reviewed all infants with a prenatal diagnosis of TOF from January 2004 to June 2011. Aortic valve (AoV), pulmonary valve (PV), main pulmonary artery (MPA), left and right pulmonary artery diameters, and ductus arteriosus flow were evaluated on fetal echocardiograms, and associations between the fetal echocardiogram and the neonatal echocardiogram measurements and outcomes were assessed.

Results

The study identified 67 TOF patients who had an initial fetal echocardiogram at a mean gestational age of 25.0 ± 5.2 weeks. Patients with absent PV syndrome or major aortopulmonary collaterals were excluded from the study, as were those without anterograde pulmonary blood flow at the first fetal echocardiogram. Of the remaining 44 patients, 10 were ductal dependent and required neonatal surgery. Infants who were ductal dependent had lower fetal PV (−5.38 ± 2.95 vs. −3.51 ± 1.66; p < 0.05) and MPA (−3.94 ± 1.66 vs. −2.87 ± 1.04; p < 0.05) z-scores. A fetal PV z-score of −5 predicted ductal dependence with 78 % sensitivity and 87 % specificity, and a PV z-score of −3 showed 100 % sensitivity and 34 % specificity (p < 0.001). Fetuses with a reversed left-to-right flow across the ductus arteriosus (DA) were more likely to be ductal dependent (odds ratio, 25; p < 0.001) than those who had normal ductal flow.

Conclusions

In TOF, fetal PV and MPA z-scores and direction of the DA blood flow predict neonatal ductal dependence. Patients with fetal PV z-scores lower than −3 or any left-to-right flow at the level of the DA should be admitted to a center where prostaglandin is available.
Literatur
3.
Zurück zum Zitat Berning RA, Silverman NH, Villegas M, Sahn DJ (1996) Reversed shunting across the ductus arteriosus or atrial septum in utero heralds severe congenital heart disease. J Am Coll Cardiol 27:481–486CrossRefPubMed Berning RA, Silverman NH, Villegas M, Sahn DJ (1996) Reversed shunting across the ductus arteriosus or atrial septum in utero heralds severe congenital heart disease. J Am Coll Cardiol 27:481–486CrossRefPubMed
4.
Zurück zum Zitat Escribano D, Herraiz I, Granados M, Arbues J, Mendoza A, Galindo A (2011) Tetralogy of Fallot: prediction of outcome in the mid-second trimester of pregnancy. Prenat Diagn 31:1126–1133PubMed Escribano D, Herraiz I, Granados M, Arbues J, Mendoza A, Galindo A (2011) Tetralogy of Fallot: prediction of outcome in the mid-second trimester of pregnancy. Prenat Diagn 31:1126–1133PubMed
5.
Zurück zum Zitat Ferencz C, Rubin JD, McCarter RJ, Brenner JI, Neill CA, Perry LW et al (1985) Congenital heart disease: prevalence at livebirth. The Baltimore-Washington Infant Study. Am J Epidemiol 121:31–36PubMed Ferencz C, Rubin JD, McCarter RJ, Brenner JI, Neill CA, Perry LW et al (1985) Congenital heart disease: prevalence at livebirth. The Baltimore-Washington Infant Study. Am J Epidemiol 121:31–36PubMed
6.
Zurück zum Zitat Friedberg MK, Silverman NH, Moon-Grady AJ, Tong E, Nourse J, Sorenson B et al (2009) Prenatal detection of congenital heart disease. J Pediatr 155(26–31):e1PubMed Friedberg MK, Silverman NH, Moon-Grady AJ, Tong E, Nourse J, Sorenson B et al (2009) Prenatal detection of congenital heart disease. J Pediatr 155(26–31):e1PubMed
7.
Zurück zum Zitat Hirji A, Bernasconi A, McCrindle BW, Dunn E, Gurofsky R, Manlhiot C et al (2010) Outcomes of prenatally diagnosed tetralogy of Fallot: implications for valve-sparing repair versus transannular patch. Can J Cardiol 26:e1–e6PubMedCentralCrossRefPubMed Hirji A, Bernasconi A, McCrindle BW, Dunn E, Gurofsky R, Manlhiot C et al (2010) Outcomes of prenatally diagnosed tetralogy of Fallot: implications for valve-sparing repair versus transannular patch. Can J Cardiol 26:e1–e6PubMedCentralCrossRefPubMed
8.
Zurück zum Zitat Hornberger LK, Sanders SP, Sahn DJ, Rice MJ, Spevak PJ, Benacerraf BR et al (1995) In utero pulmonary artery and aortic growth and potential for progression of pulmonary outflow tract obstruction in tetralogy of Fallot. J Am Coll Cardiol 25:739–745CrossRefPubMed Hornberger LK, Sanders SP, Sahn DJ, Rice MJ, Spevak PJ, Benacerraf BR et al (1995) In utero pulmonary artery and aortic growth and potential for progression of pulmonary outflow tract obstruction in tetralogy of Fallot. J Am Coll Cardiol 25:739–745CrossRefPubMed
9.
Zurück zum Zitat Lee W, Smith RS, Comstock CH, Kirk JS, Riggs T, Weinhouse E (1995) Tetralogy of Fallot: prenatal diagnosis and postnatal survival. Obstet Gynecol 86(4 Pt 1):583–588CrossRefPubMed Lee W, Smith RS, Comstock CH, Kirk JS, Riggs T, Weinhouse E (1995) Tetralogy of Fallot: prenatal diagnosis and postnatal survival. Obstet Gynecol 86(4 Pt 1):583–588CrossRefPubMed
10.
Zurück zum Zitat Levey A, Glickstein JS, Kleinman CS, Levasseur SM, Chen J, Gersony WM et al (2010) The impact of prenatal diagnosis of complex congenital heart disease on neonatal outcomes. Pediatr Cardiol 31:587–597PubMedCentralCrossRefPubMed Levey A, Glickstein JS, Kleinman CS, Levasseur SM, Chen J, Gersony WM et al (2010) The impact of prenatal diagnosis of complex congenital heart disease on neonatal outcomes. Pediatr Cardiol 31:587–597PubMedCentralCrossRefPubMed
11.
Zurück zum Zitat Pasquini L, Mellander M, Seale A, Matsui H, Roughton M, Ho SY et al (2007) Z-scores of the fetal aortic isthmus and duct: an aid to assessing arch hypoplasia. Ultrasound Obstet Gynecol 29:628–633CrossRefPubMed Pasquini L, Mellander M, Seale A, Matsui H, Roughton M, Ho SY et al (2007) Z-scores of the fetal aortic isthmus and duct: an aid to assessing arch hypoplasia. Ultrasound Obstet Gynecol 29:628–633CrossRefPubMed
12.
Zurück zum Zitat Pepas LP, Savis A, Jones A, Sharland GK, Tulloh RM, Simpson JM (2003) An echocardiographic study of tetralogy of Fallot in the fetus and infant. Cardiol Young 13:240–247PubMed Pepas LP, Savis A, Jones A, Sharland GK, Tulloh RM, Simpson JM (2003) An echocardiographic study of tetralogy of Fallot in the fetus and infant. Cardiol Young 13:240–247PubMed
13.
Zurück zum Zitat Pettersen MD, Du W, Skeens ME, Humes RA (2008) Regression equations for calculation of z-scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr 21:922–934CrossRefPubMed Pettersen MD, Du W, Skeens ME, Humes RA (2008) Regression equations for calculation of z-scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr 21:922–934CrossRefPubMed
14.
Zurück zum Zitat Rychik J, Ayres N, Cuneo B, Gotteiner N, Hornberger L, Spevak PJ et al (2004) American Society of Echocardiography guidelines and standards for performance of the fetal echocardiogram. J Am Soc Echocardiogr 17:803–810CrossRefPubMed Rychik J, Ayres N, Cuneo B, Gotteiner N, Hornberger L, Spevak PJ et al (2004) American Society of Echocardiography guidelines and standards for performance of the fetal echocardiogram. J Am Soc Echocardiogr 17:803–810CrossRefPubMed
15.
Zurück zum Zitat Schneider C, McCrindle BW, Carvalho JS, Hornberger LK, McCarthy KP, Daubeney PE (2005) Development of z-scores for fetal cardiac dimensions from echocardiography. Ultrasound Obstet Gynecol 26:599–605CrossRefPubMed Schneider C, McCrindle BW, Carvalho JS, Hornberger LK, McCarthy KP, Daubeney PE (2005) Development of z-scores for fetal cardiac dimensions from echocardiography. Ultrasound Obstet Gynecol 26:599–605CrossRefPubMed
16.
17.
Zurück zum Zitat Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH (2001) Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 103:1269–1273CrossRefPubMed Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH (2001) Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 103:1269–1273CrossRefPubMed
Metadaten
Titel
Fetal Echocardiographic Measurements and the Need for Neonatal Surgical Intervention in Tetralogy of Fallot
verfasst von
Bhawna Arya
Stéphanie M. Levasseur
Kristal Woldu
Julie S. Glickstein
Howard F. Andrews
Ismée A. Williams
Publikationsdatum
01.06.2014
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 5/2014
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-013-0857-3

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