title: Fetal pulmonary venous flow and restrictive foramen ovale in hypoplastic left heart.
abstract: OBJECTIVE
  Hypoplastic left heart (HLH) with intact or restrictive interatrial communication (HLH-IAS/RAS) is associated with high mortality rates. The object was to correlate pulmonary venous (PV) Doppler spectra and direct foramen ovale (FO) assessment with the neonatal need for early atrial septostomy (EAS) and neonatal outcome.
  
  
  METHODS
  We reviewed all prenatal echocardiograms and outcomes of 51 fetuses with HLH and information about the interatrial communication between 1994 - 2011.  IAS/RAS was defined as a small/absent interatrial shunt on 2-dimensional imaging. Three PV Doppler spectra were observed: type A: continuous forward flow with a small a wave reversal; type B: continuous forward flow with increased a-wave reversal; type C: brief to-and-fro flow.
  
  
  RESULTS
  Three of 51 neonates with type C pulmonary venous flow pattern and suspicion of IAS/RAS on 2-dimensional (2-DE) evaluation required EAS.  In one fetus pulmonary venous flow changed from type B to type C spectra throughout gestation. Fetuses with type C spectra showed a 71.4 % survival after 30 days compared to 92.3 % in fetuses with type A spectra. Short term survival after EAS was 33 %.
  
  
  CONCLUSIONS
  Prenatal PV flow pattern and 2-DE of the FO size help in identifying the fetus at risk for neonatal EAS and patient selection for fetal cardiac intervention. Most late second trimester values will not change over time.
authors.affiliation: OB&GYN, University Gießen, Division of Prenatal Medicine.
authors.forename: C
authors.initials: C
authors.lastname: Enzensberger
authors.affiliation: Department of Pediatric Cardiology, University Gießen.
authors.forename: M
authors.initials: M
authors.lastname: Vogel
authors.affiliation: OB&GYN, University Gießen, Division of Prenatal Medicine.
authors.forename: J
authors.initials: J
authors.lastname: Degenhardt
authors.affiliation: OB&GYN, University Gießen, Division of Prenatal Medicine.
authors.forename: N
authors.initials: N
authors.lastname: Fass
authors.affiliation: OB&GYN, University Gießen, Division of Prenatal Medicine.
authors.forename: A
authors.initials: A
authors.lastname: Kawecki
authors.affiliation: German Center for Fetal Surgery & Minimally Invasive Therapy, University of Gießen (DZFT).
authors.forename: T
authors.initials: T
authors.lastname: Kohl
authors.affiliation: OB&GYN, University Gießen, Division of Prenatal Medicine.
authors.forename: E
authors.initials: E
authors.lastname: Widriani
authors.affiliation: OB&GYN, University Gießen, Division of Prenatal Medicine.
authors.forename: R
authors.initials: R
authors.lastname: Axt-Fliedner
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D003971:Diastole / Q000502:physiology; D005260:Female; D054085:Foramen Ovale / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005865:Gestational Age; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007231:Infant, Newborn; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D011247:Pregnancy; D011379:Prognosis; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012189:Retrospective Studies; D013599:Systole / Q000502:physiology; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods*