[Significant aortic valve stenosis in the prenatal period--diagnosis, treatment, outcome. Two-center study].
OBJECTIVE
Retrospective analysis of the spectrum of fetal aortic valve stenosis with completed neonatal follow-up.


METHODS
Fetal echocardiograms of 12 fetuses with aortic stenosis (AS) were analyzed. Mean gestational age at the time of diagnosis was 29.6 weeks.


RESULTS
In all 12 cases critical AS has been detected. The left ventricle was estimated as small in three cases, in 7 cases as enlarged and hypokinetic LV (SF<28%) and in the next two cases the LV was well formed. In 6 AS cases, endocardial fibro-elastosis has been detected. Six fetuses presented mitral valve insufficiency; in three cases small LV mitral valve stenosis was diagnosed. Cardiomegaly occurred in 7 cases, including 5 cases with HA/CA > 0.5. Hypoplastic aorta has been detected in 2 cases and in one coarctation of the aorta. Retrograde flow in aortic arch and poor left ventricular function was diagnosed in ten cases. In 2 fetuses extracardiac malformations were present: hydrocephalus and pylorostenosis. In 83% of the cases CS had been performed and 17% were delivered vaginally (2 intrauterine fetal deaths). Four neonates had been qualified to percutaneous balloon valvuloplasty, in three cardiac surgery had been performed. Three neonates with AS (25%) survived--two after valvuloplasty (one of them required also cardiac surgery) and one after Norwood procedure.


CONCLUSIONS
1. Poor prognostic factors for neonates with critical fetal AS were as follows: small LV, retrograde flow in aortic arch, poor left ventricular function and presence of extracardiac anomalies. 2. Neonates who survived with fetal SA, had isolated CHD and well formed LV (also with endocardial fibroelastosis).
Włoch
Agata
A
Klinika Kardiologii Dzieciecej, Slaska Akademia Medyczna, Katowice. cornet@pron.pl
Respondek-Liberska
Maria
M
Sysa
Andrzej
A
Moll
Jadwiga
J
Goc
Barbara
B
Krzystolik-Ladzińska
Joanna
J
Szydłowski
Lesław
L
Włoch
Stanisław
S
Sikora
Jerzy
J
D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D005313:Fetal Death; D005500:Follow-Up Studies; D005865:Gestational Age; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016216:Ultrasonography, Prenatal