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Improved technical success, postnatal outcome and refined predictors of outcome for fetal aortic valvuloplasty
- Source :
- Ultrasound in Obstetrics & Gynecology. 52:212-220
- Publication Year :
- 2018
- Publisher :
- Wiley, 2018.
-
Abstract
- Objectives Fetal aortic valvuloplasty (FAV) may prevent progression of mid-gestation aortic stenosis to hypoplastic left heart syndrome (HLHS). The aim of this study was to evaluate whether technical success and biventricular (Biv) outcome after FAV have changed from an earlier (2000-2008) to a more recent (2009-2015) era and identify pre-FAV predictors of Biv outcome. Methods We evaluated procedural and postnatal outcomes in 123 fetuses that underwent FAV for evolving HLHS at Boston Children's Hospital between 2000 and 2015. The primary outcome measure was circulation type (Biv vs single ventricle) at the time of neonatal hospital discharge. Classification and regression tree (CART) analysis was performed to construct a stratification algorithm to predict Biv circulation based on pre-FAV fetal variables. Results The FAV procedure was technically successful in 101/123 (82%) fetuses, with a higher technical success rate in the more recent era than in the earlier one (49/52 (94%) vs 52/71 (73%); P = 0.003). In liveborn patients, the incidence of Biv outcome was higher in the recent than in the earlier era, both in the entire liveborn cohort (29/49 (59%) vs 16/62 (26%); P = 0.001) and in those in whom the procedure was technically successful (27/46 (59%) vs 15/47 (32%); P = 0.007). Independent predictors of Biv outcome were higher left ventricular (LV) pressure, larger ascending aorta, better LV diastolic function and higher LV long-axis Z-score. On CART analysis, fetuses with LV pressure > 47 mmHg and ascending aorta Z-score ≥ 0.57 had a 92% probability of Biv outcome (n = 24). Those with a lower LV pressure, or mitral dimension Z-score Conclusions The proportion of patients achieving Biv outcome after FAV has increased, probably owing to an improved technical success rate and modified selection criteria. Fetal factors, including LV pressure, size of the ascending aorta and diastolic function, are associated with likelihood of Biv circulation after FAV. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
030204 cardiovascular system & hematology
Hypoplastic left heart syndrome
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine.artery
Ascending aorta
Medicine
Radiology, Nuclear Medicine and imaging
030219 obstetrics & reproductive medicine
Radiological and Ultrasound Technology
business.industry
Obstetrics and Gynecology
Gestational age
Retrospective cohort study
General Medicine
medicine.disease
Aortic valvuloplasty
Surgery
Stenosis
medicine.anatomical_structure
Reproductive Medicine
Ventricle
Aortic valve stenosis
Cardiology
business
Subjects
Details
- ISSN :
- 09607692
- Volume :
- 52
- Database :
- OpenAIRE
- Journal :
- Ultrasound in Obstetrics & Gynecology
- Accession number :
- edsair.doi...........dcf9ec93e1cf4307cfe6a80aa22e5cab