Author + information
- Aaron Prosnitz,
- Monika Drogosz,
- Audrey Marshall,
- Carol Benson,
- Louise Wilkins-Haug,
- Wayne Tworetzky and
- Kevin Friedman
Background: In fetuses with severe mid-gestational aortic stenosis, fetal aortic valvuloplasty (FAV) can promote left ventricular growth and function, and may prevent progression to hypoplastic left heart syndrome. Previous small studies suggest that post-intervention LVEF and the presence of antegrade transverse arch flow (ATAF) several weeks after intervention are associated with biventricular outcome. We evaluate if FAV is associated with acute changes in left heart hemodynamic function, and if these changes are associated with biventricular circulation (BVC) after birth.
Methods and Results: We reviewed all technically successful FAV cases between 2000 and 2016 (n=101). FAV occurred at a mean gestational age of 24.6 weeks (19.0-31.4), with post-FAV echocardiograms occurring 0-2 days later. Of the live births (n=94), BVC was achieved in 42 subjects (45%).
Measures of left heart physiology were markedly abnormal pre-FAV and improved post-FAV. ATAF was present in 0 subjects pre-FAV and increased to 65 subjects (65%) post-FAV (p<0.0001). Pre-FAV, 86 subjects (89%) had entirely left-to-right PFO flow and 10 (10%) had bidirectional flow. Post-FAV, the number of subjects with bidirectional PFO flow increased to 20 (24%) (p=0.007). LVEF increased from 24.7% (standard deviation ±12.0) to 32.7% (±15.2) (p<0.0001). LV systolic pressure decreased from 59.1 mm Hg (±17.3) to 50.9 mm Hg (±18.6) (p=0.007). AR ≥ mild was present in 3 subjects (3%) pre-FAV and 51 subjects (53%) post-FAV (p<0.0001). MR ≥ moderate was present in 8 subjects (8%) pre-FAV and 40 subjects (41%) post-FAV (p<0.0001).
Univariate analysis demonstrated that a change in PFO flow from left-to-right to bidirectional (OR 3.62, 95% CI 1.05-12.5, p=0.041), an increase in LVEF (OR 1.05, 95% CI 1.00-1.09, p=0.037), and gaining ATAF (OR 7.5, 95% CI 2.5-22.3, p<0.0001) were associated with BVC. In multivariable analysis, gaining ATAF was the only variable that remained significantly associated with BVC.
Conclusions: Technically successful FAV in subjects with fetal aortic stenosis is associated with immediate improvements in left heart physiology that are predictive of biventricular outcome.
Room 146 C
Sunday, March 19, 2017, 8:12 a.m.-8:22 a.m.
Session Title: Highlighted Original Research: Congenital Heart Disease and the Year in Review
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 908-04
- 2017 American College of Cardiology Foundation