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

Assessment of the Ductus Arteriosus in Fetuses with Tetralogy of Fallot and the Implication for Postnatal Management

“…Our study confirms the high incidence of associated chromosomal anomalies (10%) and of ECAs (11.5%). However, our data were slightly different from those reported in the literature (which showed even a higher incidence of chromosomal anomalies and ECAs among TOF fetuses), and we believe this disagreement may be due to the prevalence of a high risk pregnant population in our study compared with those previously reported . The majority (6/12, 50%) of TOP in our study population was motivated by the presence of either a chromosomal anomaly or an ECA.…”

“…Previous studies have already demonstrated the reliability of fetal echocardiography in describing the anatomy of TOF and in predicting the type and timing of surgical intervention . Reversed ductal shunting as well as lower pulmonary valve z ‐score and a smaller MPA/AA ratio are considered highly sensitive echocardiographic predictors of RVOTO severity .…”

“…Several published reports have already described the prenatal diagnosis of TOF and in particular the echocardiographic markers that reflect the severity of RVOTO and predict the postnatal prognosis of these patients . However, there is a paucity of information about ductal morphology and flow pattern, both during gestation and immediately after birth, which in turn may have significant implications on postnatal management …”

Midgestation Fetal Pulmonary Annulus Size Is Predictive of Outcome in Tetralogy of Fallot

“…Hirji et al. report on fetal echo results from 29 to 32 weeks and show that smaller PV and lower PV : AoV are associated with need for prostaglandin and increased likelihood of TAP repair . In a study of 23 TOF patients followed pre‐ and postnatally, Escribano et al.…”

“…Only a few previous studies have evaluated the association between fetal echocardiographic (echo) parameters and postnatal outcomes in TOF, thus limiting the data available for prenatal counseling. In a small cohort of fetuses with TOF, midgestation pulmonary valve size has been shown to correlate with postnatal pulmonary valve (PV) diameter and pulmonary artery (PA) size . Prenatal counseling for parents of fetuses with TOF should ideally include information on progression of disease through the remainder of gestation, recommendation for location of delivery, likelihood of cyanosis prior to repair, timing and type of surgical repair required, and likelihood of need for reintervention after repair.…”