In foetuses with borderline left ventricle, mitral valve Z-score ⩽-1.9 and tricuspid:mitral valve ratio ⩾1.5 were 100% sensitive for predicting univentricular palliation.
Cohort (n=39)
No
Do specific foetal echocardiographic features predict the postnatal surgical choice (univentricular vs biventricular approach) in foetuses with borderline left ventricle?
Specific foetal echocardiographic measurements, such as mitral valve Z-score and ventricular dimension ratios, can effectively predict the likelihood of single-ventricle palliation versus biventricular repair in foetuses with borderline left ventricle, aiding in prenatal counselling.
p-value: p=<0.05
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%). CONCLUSION: 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.
Jantzen et al. (Wed,) conducted a cohort in Borderline left ventricle (n=39). Echocardiographic features (mitral valve Z-score, tricuspid:mitral valve ratio, right:left ventricular end-diastolic dimension ratio) was evaluated on Postnatal surgical choice (single-ventricle palliation versus biventricular repair) (p=<0.05). In foetuses with borderline left ventricle, mitral valve Z-score ⩽-1.9 and tricuspid:mitral valve ratio ⩾1.5 were 100% sensitive for predicting univentricular palliation.