title: Foetal echocardiographic assessment of borderline small left ventricles can predict the need for postnatal intervention.
abstract: BACKGROUND
  We sought to prospectively determine foetal echocardiographic factors associated with neonatal interventions in borderline hypoplastic left ventricles.
  
  
  METHODS
  Foetuses were included who had a left ventricle that was 2-4 standard deviations below normal for length or diameter and had forward flow across the mitral and aortic valves. Factors associated with an intervention in the first month of life or no need for intervention were sought using univariate and multivariate logistic regression models.
  
  
  RESULTS
  From 2005 to 2008, 47 foetuses meeting the criteria had an additional diagnosis (+foetal coarctation/+transverse arch hypoplasia): atrioventricular septal defect 7 (+2/+0), double outlet right ventricle 2 (+0/+0), Shone's complex 19 (+9/+4), and ventricular disproportion 19 (+13/+11; 4 both). There were seven pregnancies terminated, three foetal demises, and five had compassionate care. There were 32 livebirths that either had a biventricular repair (n = 20, n = 2 dead), univentricular palliation (n = 2, both alive), or no intervention (n = 9). Overall survival of livebirths to 6 months of age was 79%. Factors associated with early intervention on first foetal echocardiogram were: obstructed or retrograde arch flow (p = 0.08, odds ratio 3.3), coarctation (p = 0.05, odds ratio 11.4), and left ventricle outflow obstruction (p = 0.05, odds ratio 12.5). Neonatal factors included: Shone's diagnosis (p = 0.02, odds ratio 4.9), bicuspid aortic valve (p = 0.005, odds ratio 11.7), and larger tricuspid valve z-score (p = 0.05, odds ratio 3.6). A neonatal factor associated with no intervention was a larger mitral valve z-score (mean 23.8 versus 24.2 intervention group, p = 0.04, odds ratio 2.8).
  
  
  CONCLUSIONS
  The need for early intervention in foetuses with borderline hypoplastic left ventricle can be predicted by foetal echocardiography.
authors.affiliation: The Hospital for Sick Children, Labatt Family Heart Centre, Toronto, Ontario, Canada.
authors.forename: Roland W
authors.initials: RW
authors.lastname: Weber
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ayala-Arnez
authors.forename: Merna
authors.initials: M
authors.lastname: Atiyah
authors.forename: Yousef
authors.initials: Y
authors.lastname: Etoom
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Hickey
authors.forename: Edgar T
authors.initials: ET
authors.lastname: Jaeggi
authors.forename: Lynne E
authors.initials: LE
authors.lastname: Nield
mesh_terms: D001017:Aortic Coarctation / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004310:Double Outlet Right Ventricle / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D018618:Echocardiography, Doppler, Color; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D006343:Heart Septal Defects / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000601:surgery; D016015:Logistic Models; D015999:Multivariate Analysis; D011247:Pregnancy; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D016216:Ultrasonography, Prenatal