Document Detail


Predictors of technical success and postnatal biventricular outcome after in utero aortic valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome.
MedLine Citation:
PMID:  19786635     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Aortic stenosis in the midgestation fetus with a normal-sized or dilated left ventricle predictably progresses to hypoplastic left heart syndrome when associated with certain physiological findings. Prenatal balloon aortic valvuloplasty may improve left heart growth and function, possibly preventing evolution to hypoplastic left heart syndrome.
METHODS AND RESULTS: Between March 2000 and October 2008, 70 fetuses underwent attempted aortic valvuloplasty for critical aortic stenosis with evolving hypoplastic left heart syndrome. We analyzed this experience to determine factors associated with procedural and postnatal outcome. The median gestational age at intervention was 23 weeks. The procedure was technically successful in 52 fetuses (74%). Relative to 21 untreated comparison fetuses, subsequent prenatal growth of the aortic and mitral valves, but not the left ventricle, was improved after intervention. Nine pregnancies (13%) did not reach a viable term or preterm birth. Seventeen patients had a biventricular circulation postnatally, 15 from birth. Larger left heart structures and higher left ventricular pressure at the time of intervention were associated with biventricular outcome. A multivariable threshold scoring system was able to discriminate fetuses with a biventricular outcome with 100% sensitivity and modest positive predictive value.
CONCLUSIONS: Technically successful aortic valvuloplasty alters left heart valvar growth in fetuses with aortic stenosis and evolving hypoplastic left heart syndrome and, in a subset of cases, appeared to contribute to a biventricular outcome after birth. Fetal aortic valvuloplasty carries a risk of fetal demise. Fetuses undergoing in utero aortic valvuloplasty with an unfavorable multivariable threshold score at the time of intervention are very unlikely to achieve a biventricular circulation postnatally.
Authors:
Doff B McElhinney; Audrey C Marshall; Louise E Wilkins-Haug; David W Brown; Carol B Benson; Virginia Silva; Gerald R Marx; Arielle Mizrahi-Arnaud; James E Lock; Wayne Tworetzky
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-09-28
Journal Detail:
Title:  Circulation     Volume:  120     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-13     Completed Date:  2009-11-17     Revised Date:  2014-11-09    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1482-90     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aortic Valve / pathology,  surgery
Aortic Valve Stenosis / diagnosis,  physiopathology,  surgery*
Catheterization / methods*
Child
Child, Preschool
Cross-Sectional Studies
Female
Fetal Heart / pathology,  surgery
Fetoscopy / methods*
Follow-Up Studies
Humans
Hypoplastic Left Heart Syndrome / diagnosis,  physiopathology,  surgery*
Infant
Infant, Newborn
Male
Postoperative Period
Predictive Value of Tests
Pregnancy
Pregnancy Outcome
Prenatal Diagnosis / methods
Treatment Outcome
Ventricular Function / physiology*
Grant Support
ID/Acronym/Agency:
T32 HL007572/HL/NHLBI NIH HHS

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


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