Early hemodynamic changes after fetal aortic stenosis valvuloplasty predict biventricular circulation at birth

Objective To describe the early hemodynamic changes after fetal aortic valvuloplasty (FAV) for evolving hypoplastic left heart syndrome due to mid‐gestational aortic stenosis and to assess whether these early changes predict biventricular (BiV) circulation at neonatal discharge. Method We retrospect...

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Bibliographic Details
Published in:Prenatal diagnosis 2018-03, Vol.38 (4), p.286-292
Main Authors: Prosnitz, Aaron R., Drogosz, Monika, Marshall, Audrey C., Wilkins‐Haug, Louise E., Benson, Carol B., Sleeper, Lynn A., Tworetzky, Wayne, Friedman, Kevin G.
Format: Article
Language:English
Subjects:
Aneurysms
Aortic arch
Aortic stenosis
Aortic Valve Stenosis - physiopathology
Aortic Valve Stenosis - surgery
Blood circulation
Discharge
Female
Fetal Diseases - physiopathology
Fetal Diseases - surgery
Fetal Therapies
Fetuses
Heart
Hemodynamics
Humans
Inflow
Intervention
Male
Mitral valve
Neonates
Physiology
Pregnancy
Retrospective Studies
Stenosis
Test procedures
Treatment Outcome
Ventricle
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Summary:Objective To describe the early hemodynamic changes after fetal aortic valvuloplasty (FAV) for evolving hypoplastic left heart syndrome due to mid‐gestational aortic stenosis and to assess whether these early changes predict biventricular (BiV) circulation at neonatal discharge. Method We retrospectively reviewed all technically successful FAV cases resulting in live birth between 2000 and 2015 (n = 93, 45% BiV circulation at neonatal discharge). Paired testing methods were used to compare pre‐intervention and post‐intervention measures of left ventricular hemodynamics. Logistic regression was used to determine whether these changes were predictive of post‐natal outcome. Results Measures of left heart physiology were markedly abnormal pre‐FAV and improved significantly post‐FAV. No subjects had systolic antegrade transverse aortic arch flow pre‐FAV and 65% of subjects had antegrade flow post‐FAV. The number of subjects with abnormal left‐to‐right patent foramen ovale flow decreased, and the number with biphasic mitral valve inflow increased. The median left ventricular ejection fraction improved after intervention. Amongst the pre‐post changes, gaining partially or exclusively antegrade systolic arch flow was the most significant independent predictor of BiV circulation (OR 9.80 and 19.83, respectively, both P 
ISSN:0197-3851
1097-0223
DOI:10.1002/pd.5232