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. 2021 Mar;41(4):479-485.
doi: 10.1002/pd.5885. Epub 2021 Feb 2.

Late gestation predictors of a postnatal biventricular circulation after fetal aortic valvuloplasty

Meaghan J Beattie  1   2   3 , Kevin G Friedman  1   2 , Lynn A Sleeper  1   2 , Minmin Lu  1 , Monika Drogosz  1 , Ryan Callahan  1   2 , Audrey C Marshall  1   2   4 , Aaron R Prosnitz  1   2   5 , Terra Lafranchi  1 , Carol B Benson  6 , Louise E Wilkins-Haug  6 , Wayne Tworetzky  1   2
Affiliations

Late gestation predictors of a postnatal biventricular circulation after fetal aortic valvuloplasty

Meaghan J Beattie et al. Prenat Diagn. 2021 Mar.

Abstract

Objectives: Fetal aortic valvuloplasty (FAV) for severe aortic stenosis (AS) has shown promise in averting progression to hypoplastic left heart syndrome. After FAV, predicting which fetuses will achieve a biventricular (BiV) circulation after birth remains challenging. Identifying predictors of postnatal circulation on late gestation echocardiography will improve parental counseling.

Methods: Liveborn patients who underwent FAV and had late gestation echocardiography available were included (2000-2017, n = 96). Multivariable logistic regression and classification and regression tree analysis were utilized to identify independent predictors of BiV circulation.

Results: Among 96 fetuses, 50 (52.1%) had BiV circulation at the time of neonatal discharge. In multivariable analysis, independent predictors of biventricular circulation included left ventricular (LV) long axis z-score (OR 3.2, 95% CI 1.8-5.7, p < 0.001), LV ejection fraction (OR 1.3, 95% CI 1.0-1.8, p = 0.023), anterograde aortic arch flow (OR 5.0, 95% CI 1.2-20.4, p = 0.024), and bidirectional or right-to-left foramen ovale flow (OR 4.6, 95% CI 1.4-15.8, p = 0.015).

Conclusion: Several anatomic and physiologic parameters in late gestation were found to be independent predictors of BiV circulation after FAV. Identifying these predictors adds to our understanding of LV growth and hemodynamics after FAV and may improve parental counseling.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1:
Figure 1:
Study population. Patients were excluded from analysis if they did not survive to neonatal discharge, if there was no late gestation fetal echocardiogram available for review, or if FAV was technically unsuccessful. FAV, fetal aortic valvuloplasty.
Figure 2.
Figure 2.
Classification and regression tree analysis for prediction of biventricular circulation outcome; sensitivity 72%, specificity 89%, accuracy 80%. LV, left ventricular; MV, mitral valve.
See this image and copyright information in PMC

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