Prenatal tricuspid valve size as a predictor of postnatal outcome in patients with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum.
BACKGROUND
Tricuspid valve (TV) size at birth correlates with intervention strategy in patients with severe pulmonary stenosis (SPS) or pulmonary atresia/intact ventricular septum (PA/IVS). Prenatal features that might predict postnatal TV size have not been well studied. We hypothesized that prenatal echocardiographic measurements predict the postnatal TV Z-score in fetuses with SPS and PA/IVS.


METHODS
We identified 16 neonates (gestational age 28 ± 4.8 weeks) with a fetal diagnosis of SPS or PA/IVS from 2001 to 2010. Measurements were performed offline. ROC (receiver operating characteristic) analysis was used to generate AUC (areas under the curve) for each of the variables.


RESULTS
AUC was 0.94 for tricuspid to mitral valve (TV/MV) ratio, 0.88 for TV Z-score, and 0.85 for TV inflow duration. A cut-off value of >0.63 for TV/MV yielded a sensitivity of 78%, specificity of 100% for predicting postnatal TV Z-score >-3. Neonates with TV Z-score ≥-3 and all fetuses with antegrade flow across the pulmonary valve or more than moderate tricuspid regurgitation had biventricular circulation in follow-up.


CONCLUSIONS
Fetal TV/MV >0.63 predicts favorable TV Z-score at birth in patients with SPS and PA/IVS. Antegrade pulmonary valve flow and more than moderate tricuspid regurgitation also conferred a favorable outcome.
Department of Pediatrics, University of California, San Francisco, Calif., USA.
Alexander
A
Lowenthal
Breniel
B
Lemley
Alaina K
AK
Kipps
Michael M
MM
Brook
Anita J
AJ
Moon-Grady
D004452:Echocardiography; D006801:Humans; D011379:Prognosis; D018633:Pulmonary Atresia / Q000000981:diagnostic imaging*; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014261:Tricuspid Valve / Q000000981:diagnostic imaging*; D016216:Ultrasonography, Prenatal; D054088:Ventricular Septum / Q000000981:diagnostic imaging