Document Detail


Fetal tricuspid valve size and growth as predictors of outcome in pulmonary atresia with intact ventricular septum.
MedLine Citation:
PMID:  16882782     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Pulmonary atresia with intact ventricular septum is a complex congenital cardiovascular anomaly that frequently requires single ventricle palliation. Fetal diagnosis of pulmonary atresia with intact ventricular septum is common, but the natural history of pulmonary atresia with intact ventricular septum diagnosed in midgestation, predictors of neonatal anatomy, and predictors of biventricular repair have not been determined. The objective of this study was to determine whether the size and rate of growth of the fetal tricuspid valve predict neonatal anatomy and biventricular repair. DESIGN AND RESULTS: Twenty-three fetuses diagnosed with pulmonary atresia with intact ventricular septum between 1990 and 2004 were studied. Of 13 fetuses with a midgestation fetal tricuspid valve z score < or = -3, 1 achieved biventricular repair, compared with 5 of 5 with a tricuspid valve z score > -3. Of 13 fetuses with a midgestation fetal tricuspid valve z score < or = -3, 8 were diagnosed postnatally with a right ventricular dependent coronary circulation, compared with none with a tricuspid valve z score > -3. Midgestation and late gestation fetal tricuspid valve z scores correlated with neonatal tricuspid valve z score. The average rate of tricuspid valve growth between mid- and late fetal echocardiograms was significantly lower in patients who did not achieve biventricular repair than in those who did (0.012 +/- 0.008 cm per week vs 0.028 +/- 0.014 cm per week). CONCLUSIONS: Fetal tricuspid valve z score and rate of growth predict postnatal outcome in pulmonary atresia with intact ventricular septum. These findings may have important implications for prenatal counseling and selection of patients for fetal pulmonary valve dilation.
Authors:
Joshua W Salvin; Doff B McElhinney; Steven D Colan; Kimberlee Gauvreau; Pedro J del Nido; Kathy J Jenkins; James E Lock; Wayne Tworetzky
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatrics     Volume:  118     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-02     Completed Date:  2006-09-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e415-20     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Cardiac ICU Office, Farley 6, Children's Hospital Boston, 300 Longwood Ave, Boston, Massachusetts 02115, USA. joshua.salvin@cardio.chboston.org
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical
Arteriovenous Shunt, Surgical
Coronary Angiography
Disease Progression
Female
Fetal Diseases / pathology*,  ultrasonography
Fetal Heart / pathology*,  physiopathology,  ultrasonography
Follow-Up Studies
Fontan Procedure
Forecasting
Gestational Age
Heart Catheterization
Heart Septum / embryology,  ultrasonography
Humans
Infant, Newborn
Life Tables
Male
Palliative Care
Pulmonary Artery / surgery
Pulmonary Atresia / complications,  embryology,  pathology*,  radiography,  surgery,  ultrasonography
Tricuspid Valve / embryology*,  physiopathology,  ultrasonography
Ultrasonography, Prenatal
Vena Cava, Superior / surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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