title: Echocardiographic factors discriminating biventricular versus univentricular approach in the foetus with borderline left ventricle.
abstract: BACKGROUND
  The term "borderline left ventricle" describes a small left heart that may be inadequate to provide systemic cardiac output and implies the potential need for a single-ventricle palliation. The aim of this study was to identify foetal echocardiographic features that help discriminate which infants will undergo single-ventricle palliation versus biventricular repair to aid in prenatal counselling.
  
  
  METHODS
  The foetal database at our institution was searched to identify all foetuses with borderline left ventricle, as determined subjectively by a foetal cardiologist, from 2000 to 2011. The foetal images were retrospectively analysed for morphologic and physiologic features to determine which best predicted the postnatal surgical choice.
  
  
  RESULTS
  Of 39 foetuses identified with borderline left ventricle, 15 were planned for a univentricular approach, and 24 were planned for a biventricular approach. There were significant differences between the two outcome groups in the Z-scores of the mitral valve annulus, left ventricular end-diastolic dimension, aortic valve annulus, and ascending aorta diameter (p<0.05). With respect to discriminating univentricular outcomes, cut-offs of mitral valve Z-score ⩽-1.9 and tricuspid:mitral valve ratio ⩾1.5 were extremely sensitive (100%), whereas a right:left ventricular end-diastolic dimension ratio ⩾2.1 provided the highest specificity (95.8%).
  
  
  CONCLUSIONS
  In foetuses with borderline left ventricle, a mitral valve Z-score ⩾-1.9 or a tricuspid:mitral valve ratio ⩽1.5 suggests a high probability of biventricular repair, whereas a right:left ventricular end-diastolic dimension ratio ⩾2.1 confers a likelihood of single-ventricle palliation.
authors.affiliation: University of Michigan Congenital Heart Center,C.S. Mott Children's Hospital,Ann Arbor,Michigan,United States of America.
authors.forename: David W
authors.initials: DW
authors.lastname: Jantzen
authors.affiliation: University of Michigan Congenital Heart Center,C.S. Mott Children's Hospital,Ann Arbor,Michigan,United States of America.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Gelehrter
authors.affiliation: University of Michigan Congenital Heart Center,C.S. Mott Children's Hospital,Ann Arbor,Michigan,United States of America.
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.affiliation: University of Michigan Congenital Heart Center,C.S. Mott Children's Hospital,Ann Arbor,Michigan,United States of America.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Donohue
authors.affiliation: University of Michigan Congenital Heart Center,C.S. Mott Children's Hospital,Ann Arbor,Michigan,United States of America.
authors.forename: Carlen G
authors.initials: CG
authors.lastname: Fifer
mesh_terms: D003937:Diagnosis, Differential; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal
keywords: CHD; Foetal echocardiogram; borderline left ventricle; hypoplastic left heart