Abstract
BackgroundTo assess fetal cardiac parameters predictive of postnatal operation type in fetuses with tetralogy of Fallot (TOF).MethodsEchocardiographic data obtained in the second and third trimesters were retrospectively reviewed for fetuses diagnosed with TOF between 2014 and 2018 at Asan Medical Center. The following fetal cardiac parameters were analyzed: 1) pulmonary valve annulus (PVA) z-score, 2) right pulmonary artery (RPA) z-score, 3) aortic valve annulus (AVA) z-score, 4) pulmonary valve peak systolic velocity (PV-PSV), 5) PVA/AVA ratio, and 6) RPA/descending aorta (DAo) ratio. These cardiac parameters were compared between a primary corrective surgery group and a palliative shunt operation followed by complete repair group.ResultsA total of 100 fetuses with TOF were included. Only one neonatal death occurred. Ninety patients underwent primary corrective surgery and 10 neonates underwent a multistage surgery. The PVA z-score, RPA z-score, and RPA/DAo ratio measured in the second trimester and the PVA z-score, RPA z-score, and PVA/AVA raio measured in the third trimester were significantly lower in the multistage surgery group, while the PV-PSV as measured in both trimesters were significantly higher in the multistage surgery group.ConclusionFetal cardiac parameters are useful for predicting the operation type necessary for neonates with TOF.
Highlights
To assess fetal cardiac parameters predictive of postnatal operation type in fetuses with tetralogy of Fallot (TOF)
We evaluated the cardiac parameters of fetuses prenatally diagnosed and postnatally confirmed to have TOF to support the prediction of postnatal operation type
The Pulmonary valve annulus (PVA) z-score, Right pulmonary artery (RPA) z-score, and RPA/Descending Aorta (DAo) ratio measured in the second trimester and the PVA z-score, RPA z-score, and PVA/Aortic valve annulus (AVA) ratio measured in the third trimester were significantly lower in the multistage surgery group, while the Pulmonary valve-peak systolic velocity (PV-PSV) as measured in both trimesters were significantly higher in the multistage surgery group
Summary
To assess fetal cardiac parameters predictive of postnatal operation type in fetuses with tetralogy of Fallot (TOF). The diagnosis of TOF is commonly made during the fetal period with a high degree of accuracy [1, 3]. According to the degree of right ventricular outflow tract (RVOT) obstruction, TOF can manifest as a variety of clinical presentations ranging from asymptomatic detection to early postnatal cyanosis requiring urgent treatment. TOF with the exception pf pulmonary atresia with VSD can be divided into two types depending on the size of the pulmonary artery (PA) and the type of surgery. Type 1 patients, who have normal-sized PA and mild PS, usually undergo primary corrective surgery in the first year of life [4, 5] [6]. Type 2 patients, who have small-sized PA and severe cyanosis, require
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