title: Tetralogy of Fallot: prediction of outcome in the mid-second trimester of pregnancy.
abstract: OBJECTIVE
  To evaluate the usefulness of fetal echocardiography in the mid-second trimester in predicting postnatal outcome of tetralogy of Fallot (ToF), focusing on the need for early intervention (EI) and surgery type: pulmonary valve-sparing surgery (PVSS) versus placement of transannular patch (TAP).
  
  
  METHODS
  Assessment of cardiac morphological and functional parameters in 23 live-born fetuses with isolated ToF was performed at 19 to 22 and 34 to 38  weeks. Comparisons were made between outcome groups (EI vs non-EI and PVSS vs TAP). EI was considered as requirement either of palliative procedure or corrective surgery before three months.
  
  
  RESULTS
  Overall survival was 96%. EI was required in 32% of cases and TAP in 50%. At 19 to 22  weeks, a pulmonary valve peak systolic velocity (PVPSV) ≥87.5 cm/s predicted EI with 100% sensitivity and 93.3% specificity (p < 0.01). At 34 to 38  weeks, the size of the pulmonary valve, pulmonary valve/aortic valve and main pulmonary artery/ascending aorta were significantly different, but the PVPSV again yielded the best performance: all cases undergoing EI and/or TAP were selected using cut-off of ≥144.5 cm/s.
  
  
  CONCLUSIONS
  The postnatal outcome of fetuses with ToF may be established using PVPSV from the mid-second trimester. This may be useful in providing the most appropriate perinatal management and accurate parental counselling.
authors.affiliation: Department of Obstetrics and Gynaecology, Hospital Universitario '12 de Octubre', Madrid, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Escribano
authors.forename: I
authors.initials: I
authors.lastname: Herraiz
authors.forename: Ma
authors.initials: M
authors.lastname: Granados
authors.forename: J
authors.initials: J
authors.lastname: Arbues
authors.forename: A
authors.initials: A
authors.lastname: Mendoza
authors.forename: A
authors.initials: A
authors.lastname: Galindo
mesh_terms: D004452:Echocardiography; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011379:Prognosis; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging*; D016216:Ultrasonography, Prenatal