title: Outcomes and Predictors of Perinatal Mortality in Fetuses With Ebstein Anomaly or Tricuspid Valve Dysplasia in the Current Era: A Multicenter Study.
abstract: BACKGROUND
  Ebstein anomaly and tricuspid valve dysplasia are rare congenital tricuspid valve malformations associated with high perinatal mortality. The literature consists of small, single-center case series spanning several decades. We performed a multicenter study to assess the outcomes and factors associated with mortality after fetal diagnosis in the current era.
  
  
  RESULTS
  Fetuses diagnosed with Ebstein anomaly and tricuspid valve dysplasia from 2005 to 2011 were included from 23 centers. The primary outcome was perinatal mortality, defined as fetal demise or death before neonatal discharge. Of 243 fetuses diagnosed at a mean gestational age of 27±6 weeks, there were 11 lost to follow-up (5%), 15 terminations (6%), and 41 demises (17%). In the live-born cohort of 176 live-born patients, 56 (32%) died before discharge, yielding an overall perinatal mortality of 45%. Independent predictors of mortality at the time of diagnosis were gestational age <32 weeks (odds ratio, 8.6; 95% confidence interval, 3.5-21.0; P<0.001), tricuspid valve annulus diameter z-score (odds ratio, 1.3; 95% confidence interval, 1.1-1.5; P<0.001), pulmonary regurgitation (odds ratio, 2.9; 95% confidence interval, 1.4-6.2; P<0.001), and a pericardial effusion (odds ratio, 2.5; 95% confidence interval, 1.1-6.0; P=0.04). Nonsurvivors were more likely to have pulmonary regurgitation at any gestational age (61% versus 34%; P<0.001), and lower gestational age and weight at birth (35 versus 37 weeks; 2.5 versus 3.0 kg; both P<0.001).
  
  
  CONCLUSIONS
  In this large, contemporary series of fetuses with Ebstein anomaly and tricuspid valve dysplasia, perinatal mortality remained high. Fetuses with pulmonary regurgitation, indicating circular shunt physiology, are a high-risk cohort and may benefit from more innovative therapeutic approaches to improve survival.
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Lindsay R
authors.initials: LR
authors.lastname: Freud
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Maria C
authors.initials: MC
authors.lastname: Escobar-Diaz
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Brian T
authors.initials: BT
authors.lastname: Kalish
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Rukmini
authors.initials: R
authors.lastname: Komarlu
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Michael D
authors.initials: MD
authors.lastname: Puchalski
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Edgar T
authors.initials: ET
authors.lastname: Jaeggi
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Anita L
authors.initials: AL
authors.lastname: Szwast
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Grace
authors.initials: G
authors.lastname: Freire
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Stéphanie M
authors.initials: SM
authors.lastname: Levasseur
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Ann
authors.initials: A
authors.lastname: Kavanaugh-McHugh
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Erik C
authors.initials: EC
authors.lastname: Michelfelder
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Moon-Grady
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Mary T
authors.initials: MT
authors.lastname: Donofrio
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Howley
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Elif Seda Selamet
authors.initials: ES
authors.lastname: Tierney
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Bettina F
authors.initials: BF
authors.lastname: Cuneo
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Shaine A
authors.initials: SA
authors.lastname: Morris
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Jay D
authors.initials: JD
authors.lastname: Pruetz
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Mary E
authors.initials: ME
authors.lastname: van der Velde
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: John P
authors.initials: JP
authors.lastname: Kovalchin
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Ikemba
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Vernon
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Cyrus
authors.initials: C
authors.lastname: Samai
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Gary M
authors.initials: GM
authors.lastname: Satou
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Nina L
authors.initials: NL
authors.lastname: Gotteiner
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Colin K
authors.initials: CK
authors.lastname: Phoon
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Norman H
authors.initials: NH
authors.lastname: Silverman
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
authors.affiliation: From Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Department of Pediatrics, MA (L.R.F., M.C.E.-D., R.K., W.T.); Boston Children's Hospital, Department of Medicine, Harvard Medical School, Department of Pediatrics, MA (B.T.K.); Primary Children's Hospital, University of Utah School of Medicine, Department of Pediatrics, Division of Cardiology, Salt Lake City (M.D.P.); Hospital for Sick Children, University of Toronto Faculty of Medicine, Department of Pediatrics, Division of Cardiology, ON, Canada (E.T.J.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Cardiology, PA (A.L.S.); All Children's Hospital, Johns Hopkins Medicine, Department of Pediatrics, Division of Cardiology, St. Petersburg, FL (G.F.); Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, Division of Cardiology, New York (S.M.L.); Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Department of Pediatrics, Division of Cardiology, Nashville, TN (A.K.-M.); Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, The Heart Institute, OH (E.C.M.); UCSF Benioff Children's Hospital, University of California-San Francisco School of Medicine, Department of Pediatrics, Division of Cardiology (A.J.M.-G., N.H.S.); Children's National Medical Center, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC (M.T.D.); Heart Institute Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Division of Cardiology, Aurora (L.W.H.); Lucile Packard Children's Hospital, Stanford School of Medicine, Department of Pediatrics, Division of Cardiology, Palo, Alto, CA (E.S.S.T., N.H.S., D.B.M.); Advocate Children's Hospital, Oak
authors.forename: Wayne
authors.initials: W
authors.lastname: Tworetzky
mesh_terms: D000025:Abortion, Eugenic; D000328:Adult; D001724:Birth Weight; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D004314:Down Syndrome / Q000150:complications / Q000401:mortality; D004437:Ebstein Anomaly / Q000000981:diagnostic imaging / Q000196:embryology / Q000401:mortality* / Q000601:surgery; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000196:embryology / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality; D008297:Male; D010166:Palliative Care; D010490:Pericardial Effusion / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000209:etiology / Q000601:surgery; D016216:Ultrasonography, Prenatal; D055815:Young Adult
keywords: Ebstein anomaly; echocardiography; heart defects, congenital; mortality; tricuspid valve insufficiency