Key result
Endocardial fibroelastosis on prenatal echocardiography was significantly more common in fetuses requiring single-ventricle palliation compared to biventricular repair (80% vs 10%, p<0.001).
Why the study?
Prenatal prediction of postnatal univentricular versus biventricular circulation in patients with borderline left ventricle remains challenging.
Do prenatal fetal echocardiographic parameters predict postnatal surgical outcomes in fetuses with borderline left ventricle?
Cohort (n=54)
Yes
Do prenatal fetal echocardiographic parameters predict postnatal surgical outcomes in fetuses with borderline left ventricle?
Prenatal fetal echocardiographic parameters, specifically endocardial fibroelastosis, retrograde arch flow, and LV sphericity, can help predict postnatal circulation outcomes in patients with borderline left ventricle.
Endocardial fibroelastosis may aid prenatal risk stratification for single-ventricle palliation; hypothesis-generating and requires validation before guiding decisions.
OBJECTIVES: Prenatal prediction of postnatal univentricular versus biventricular circulation in patients with borderline left ventricle (bLV) remains challenging. This study investigated prenatal fetal echocardiographic parameters and postnatal outcome of patients with a prenatally diagnosed bLV. METHODS: We report a retrospective study of bLV patients at four prenatal centers with a follow-up of one year. BLV was defined as z-scores of the left ventricle (LV) between -2 and -4. Single-ventricle palliation (SVP), biventricular repair (BVR), and no surgical or catheter-based intervention served as the dependent outcome. Prenatal ultrasound parameters were used as independent variables. Cut-off values from receiver operating characteristic curves (ROC) were determined for significant discrimination between outcomes. RESULTS: A total of 54 patients were diagnosed with bLV from 2010 to 2018. All were live births. Out of the entire cohort, 8 (15 %) received SVP, 34 (63 %) BVR, and 12 (22 %) no intervention. There was no significant difference with regard to genetic or extracardiac anomalies. There were significantly more patients with endocardial fibroelastosis (EFE) in the SVP group compared to the BVR group (80 % vs. 10 %), (p < 0.001). Apex-forming LV (100 % vs. 70 %) and lack of retrograde arch flow (20 % vs. 80 %) were associated with no intervention (p < 0.001). With respect to BVR vs. SVP, the LV sphericity index provided the highest specificity (91.7 %) using a cutoff value of ≤ 0.5. CONCLUSION: The majority of bLV patients maintained biventricular circulation. EFE, retrograde arch flow, and LV sphericity can be helpful parameters for counseling parents and further prospective studies can be developed.
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Vorisek et al. (2021) conducted a cohort in Borderline left ventricle (n=54). Prenatal fetal echocardiographic parameters (e.g., endocardial fibroelastosis, LV sphericity index) was evaluated on Postnatal outcome (single-ventricle palliation, biventricular repair, or no intervention). Endocardial fibroelastosis on prenatal echocardiography was significantly more common in fetuses requiring single-ventricle palliation compared to biventricular repair (80% vs 10%, p<0.001).
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