360 Fetal pulmonary vein doppler flow pattern: Predicting the need for immediate left atrial decompression in hypoplastic left heart syndrome with restrictive atrial septum

Abstract

BACKGROUND: Fetal pulmonary venous (PV) Doppler flow has been correlated with the severity of atrial septal restriction (ASR) and the need for emergent atrial septostomy (EAS) in newborns with HLHS. According to Michelfelder et al (JTCS 2011), a fetal forward/reverse PV Doppler flow velocity-time integral (PV VTI) ratio 5 predicted the need for EAS, required in 21% of their 39 HLHS cases, with a sensitivity of 100% and a specificity of 94%. We reviewed our contemporary institutional experience with this entity. METHODS: Echocardiograms and outcomes of 67 consecutive fetal HLHS cases with active postnatal management were reviewed. PV Doppler assessments included maximal S-, Dand A-wave flow velocities (cm/s); A-wave duration (ms), S/D wave and forward/reverse PV VTI ratios. EAS 1 days of age and survival to infancy were used as clinical outcome variables. RESULTS: Four (6%) of the 67 cases required an EAS for an intact (n 1) or severely restrictive atrial septum. The table indicates the median (range) fetal PV Doppler indices at the pre-delivery echocardiogram of newborns with/without EAS: