Outcomes of prenatally diagnosed tetralogy of Fallot: Implications for valve-sparing repair versus transannular patch.
OBJECTIVE
To assess outcomes of prenatally diagnosed tetralogy of Fallot and determine factors associated with the choice to undergo a valvesparing repair versus transannular patch, and the use of prostaglandins at birth.


METHODS
All cases at The Hospital for Sick Children (Toronto, Ontario) with a fetal diagnosis of tetralogy of Fallot from 1998 to 2006, were reviewed for demographic and fetal echocardiographic data to determine factors associated with the valve-sparing repair and need for perinatal support.


RESULTS
Sixty-four fetuses met inclusion criteria (median gestational age 22 weeks) with 47 live births. Twenty-six underwent valve-sparing repair (median age 5.7 months) and 14 underwent transannular patch repair (median age 4.5 months). There were seven deaths before surgery and one post-transannular patch repair. One patient required a transannular patch repair after the initial valve-sparing repair. Twelve of 29 (41%) patients received prostaglandins at birth. Type of surgical repair, use of prostaglandins and postnatal death were among the outcomes investigated. The mean pulmonary valve (PV) z-score was -3.0+/-2.0 and the mean PV/aortic valve (AoV) ratio was 0.65+/-0.10. Lower PV z-score (P=0.04), smaller PV/AoV ratio (P=0.04) and the presence of nonantegrade arterial duct flow (P=0.02) were associated with prostaglandin use. A higher PV/AoV ratio was associated with valvesparing repair (P=0.04). Fetal z-scores of the PV, AoV and right pulmonary artery at 29 to 32 weeks gestational age correlated with respective postnatal z-scores (P=0.01).


CONCLUSIONS
Fetal echocardiographic variables were associated with the use of prostaglandins and valve-sparing repair in fetuses with tetralogy of Fallot, and at 29 weeks, correlated with postnatal valve diameters.
Hirji
A
A
The Hospital for Sick Children, Labatt Family Heart Centre, Toronto, Canada.
Bernasconi
A
A
McCrindle
B W
BW
Dunn
E
E
Gurofsky
R
R
Manlhiot
C
C
Miner
S E
SE
Kingdom
J C
JC
Jaeggi
E T
ET
Van Arsdell
G
G
Nield
L E
LE
D000015:Abnormalities, Multiple / Q000401:mortality; D001021:Aortic Valve / Q000000981:diagnostic imaging; D001724:Birth Weight; D006348:Cardiac Surgical Procedures; D002869:Chromosome Aberrations; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011465:Prostaglandins, Synthetic / Q000627:therapeutic use; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000517:prevention & control; D016019:Survival Analysis; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D014463:Ultrasonography; D014694:Ventricular Outflow Obstruction / Q000601:surgery
D011465:Prostaglandins, Synthetic