title: Fetal aortic valve stenosis: a critique of case selection criteria for fetal intervention.
abstract: OBJECTIVE
  Selection of fetuses with aortic stenosis (AS) for prenatal intervention has been influenced by published scoring systems. This study aimed to test these scoring systems by retrospective application to consecutive cases of fetal AS.
  
  
  METHODS
  Retrospective analysis of the echocardiographic findings of 31 consecutive fetuses with AS evaluated at a tertiary fetal cardiology centre. Published 'eHLHS' scores and threshold scores were applied to the group and compared to postnatal management, in terms of biventricular repair versus single ventricle palliation.
  
  
  RESULTS
  Thirty-one fetuses were identified with AS, and eHLHS was identified in 17 at the initial echocardiogram. No fetus with a full eHLHS score (3/3 or 4/4) achieved a biventricular repair. Three fetuses had a favourable threshold score (≥4), one of whom had a successful biventricular outcome. Seven fetuses had an unfavourable threshold score (<4) and underwent a univentricular pathway.
  
  
  CONCLUSIONS
  The eHLHS score is a reliable predictor for the progression to HLHS at term. The score identifies those who would achieve a biventricular repair postnatally without prenatal intervention. A minority of fetuses with favourable threshold scores may achieve a biventricular repair postnatally without prenatal intervention, but eHLHS and an unfavourable threshold score (<4) predict a single ventricle pathway postnatally.
authors.affiliation: Department of Congenital Heart Disease, Royal Hospital for Children, Glasgow, UK.
authors.forename: Lindsey E
authors.initials: LE
authors.lastname: Hunter
authors.affiliation: Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK.
authors.forename: Henry
authors.initials: H
authors.lastname: Chubb
authors.affiliation: Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK.
authors.forename: Owen
authors.initials: O
authors.lastname: Miller
authors.affiliation: Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK.
authors.forename: Gurleen
authors.initials: G
authors.lastname: Sharland
authors.affiliation: Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK.
authors.forename: John M
authors.initials: JM
authors.lastname: Simpson
mesh_terms: D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000209:etiology / Q000517:prevention & control*; D018579:Patient Selection; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index