Pulmonary atresia/critical stenosis with intact ventricular septum: prediction of outcome in the second trimester of pregnancy

Abstract

The postnatal outcome of fetuses with PA-CS/IVS can be predicted in the second trimester at the first echocardiography by a four-criterion scoring system. This is clinically relevant since it allows early selection of candidates for fetal intervention and early and precise parental counseling.

Prenatal Tricuspid Valve Size as a Predictor of Postnatal Outcome in Patients with Severe Pulmonary Stenosis or Pulmonary Atresia with Intact Ventricular Septum

“…Looking at UV palliation as an outcome, Roman et al [6] found that a cut-off value of <0.7 for TV/MV ratio yielded a sensitivity of 100% and a specificity of 75%, which is similar to our findings. A slightly higher cut-off for TV/MV ratio of >0.83 was utilized in the 4-point scoring system proposed by Gomez-Montes et al [7]. Utilizing statistical modeling, Gardiner et al [8] devised the right atrial pressure (RAP) score to predict single versus BV outcome in the fetus with PA/IVS.…”

“…There have been previous articles that attempted to predict BV vs. UV outcome in this unique patient population utilizing fetal morphologic and hemodynamic parameters [6,7,8,10,11]. Prenatal echocardiographic features that might specifically predict postnatal TV size Z-score have not been as well studied.…”

“…Thus, both postnatally and, more importantly prenatally, at diagnosis the counseling health practitioner has to be able to predict the likeliness of a univentricular (including the possibility of 1.5 ventricle) (UV) or biventricular (BV) repair, and if UV repairs appears the imminent outcome, whether fetal pulmonary valve balloon valvuloplasty with its associated risks should be offered [6,7,8]. …”

327: Prenatal tricuspid valve size as a predictor of postnatal outcome in patients with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum

“…We did not have longitudinal data for analysis during these pregnancies; TV annulus growth may be impaired through gestation (crossing Z-score lines) as is true in all forms of left and right outflow obstruction [4] . RV length as well may progressively shorten in critical outflow lesions with little ventricular inflow [6][7][8] . Unfortunately, due to the high pregnancy termination rates in our study and in others, there are not sufficient available data to prognosticate well-based earlier observations and subsequent growth velocities, therefore extrapola- …”

Fetal Echocardiography and Prenatal Cardiovascular Interventions – An Update (2012)

“…This study was limited by lack of sufficient predictors of progressive RV hypoplasia making it difficult ISSN:2155-9880 JCEC, an open access journal Congenital Heart Disease-Recent Discoveries and Innovations J Clin Exp Cardiolog to ascertain the impact of intervention on ventricular growth. Recent reviews of the evolution of severe pulmonary outflow tract obstruction have identified morphological and functional features more likely associated with the evolution of the small right heart, including size of the tricuspid and pulmonary valves and right ventricular inflow duration, which will guide attempts at fetal pulmonary valvuloplasty in the future [88,89,137]. Therefore, although technical success is possible for fetal aortic and pulmonary valvulopasty and atrial septoplasty, we are far from routine application of these techniques.…”