Key result
Truncal valve stenosis is linked to a ~25% increase in presurgical death in truncus arteriosus.
Why the study?
Fetal and neonatal outcomes and factors increasing mortality risk in fetal truncus arteriosus are not well characterized.
What are the prenatal predictors of fetal and neonatal death in truncus arteriosus?
Cohort (n=378)
Yes
What are the prenatal predictors of fetal and neonatal death in truncus arteriosus?
Truncal valve stenosis and preterm birth are significant predictors of presurgical death in fetuses with truncus arteriosus, highlighting the importance of serial prenatal echocardiographic assessment for prognostication.
Truncal valve stenosis flags higher presurgical mortality risk in fetal truncus arteriosus; hypothesis-generating and requires prospective validation before guiding care.
BACKGROUND: Fetal and neonatal outcomes and factors increasing mortality risk in fetal truncus arteriosus are not well characterized. We aimed to examine the prenatally encountered cardiac spectrum, define extracardiac and genetic associations, explore clinical outcomes and identify prenatal factors associated with worse outcomes in a contemporary large cohort. METHODS: A multicenter retrospective cohort study was conducted via the Fetal Heart Society Research Collaborative including fetal truncus arteriosus cases encountered between January 1, 2010, and September 1, 2021, within 22 North American cardiac centers. Demographic, clinical, anatomic, and functional fetal echocardiographic variables were analyzed for associations with presurgical death (fetal death/neonatal presurgical death/neonatal listing for heart transplantation before initial hospital discharge). Variables were compared between survivors and nonsurvivors with nonparametric tests and univariable logistic regression; a multivariable linear probability model was used for further assessment after adjusting for confounders. RESULTS: Of 378 fetuses diagnosed prenatally, 201 (53.2%) had a genetic abnormality or extracardiac anomaly identified. Pregnancy termination was chosen in 47 (12.4%) pregnancies and palliative care in 13 (3.4%). Of 318 pregnancies with intention to treat, 17 (5.3%) ended in fetal death and 19 (6%) in neonatal presurgical death. In addition to prematurity and low birth weight, truncal valve stenosis (but not regurgitation or anatomic subtype) and ventricular dysfunction were associated with presurgical death. CONCLUSIONS: Half of fetuses with truncus arteriosus will have an associated genetic abnormality or extracardiac anomaly. Truncal valve stenosis and ventricular dysfunction, as well as preterm birth and low birth weight, are associated with presurgical death. These data are important for prognostication and prenatal counseling.
No takes yet. Share an insight, caveat, or question.
Cox et al. (2026) conducted a cohort in Fetal truncus arteriosus (n=378). Truncal valve stenosis (peak velocity >2.5 m/s) vs. Absence of truncal valve stenosis was evaluated on Presurgical death (fetal death, presurgical neonatal death, or neonatal listing for heart transplantation before initial hospital discharge) (25.3-percentage-point increase, p=0.001). In fetuses with prenatally diagnosed truncus arteriosus, the presence of truncal valve stenosis was associated with a 25.3-percentage-point increase in presurgical death.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: