Key result
A fetal tricuspid to mitral valve ratio >0.63 strongly predicted a favorable postnatal tricuspid valve Z-score >-3 with an AUC of 0.94, 78% sensitivity, and 100% specificity.
Why the study?
Do prenatal echocardiographic measurements predict postnatal tricuspid valve size and biventricular outcome in fetuses with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum?
Observational (n=22)
No
Do prenatal echocardiographic measurements predict postnatal tricuspid valve size and biventricular outcome in fetuses with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum?
Effect estimate: AUC 0.94
p-value: p=0.002
A fetal tricuspid to mitral valve ratio >0.63 strongly predicts a favorable postnatal tricuspid valve Z-score and biventricular circulation in fetuses with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum.
May aid prenatal counseling on biventricular potential; leaves open prospective validation before practice change.
INTRODUCTION: Tricuspid valve (TV) size at birth correlates with intervention strategy in patients with severe pulmonary stenosis (SPS) or pulmonary atresia/intact ventricular septum (PA/IVS). Prenatal features that might predict postnatal TV size have not been well studied. We hypothesized that prenatal echocardiographic measurements predict the postnatal TV Z-score in fetuses with SPS and PA/IVS. MATERIALS AND METHODS: We identified 16 neonates (gestational age 28 ± 4.8 weeks) with a fetal diagnosis of SPS or PA/IVS from 2001 to 2010. Measurements were performed offline. ROC (receiver operating characteristic) analysis was used to generate AUC (areas under the curve) for each of the variables. RESULTS: AUC was 0.94 for tricuspid to mitral valve (TV/MV) ratio, 0.88 for TV Z-score, and 0.85 for TV inflow duration. A cut-off value of >0.63 for TV/MV yielded a sensitivity of 78%, specificity of 100% for predicting postnatal TV Z-score >-3. Neonates with TV Z-score ≥-3 and all fetuses with antegrade flow across the pulmonary valve or more than moderate tricuspid regurgitation had biventricular circulation in follow-up. CONCLUSION: Fetal TV/MV >0.63 predicts favorable TV Z-score at birth in patients with SPS and PA/IVS. Antegrade pulmonary valve flow and more than moderate tricuspid regurgitation also conferred a favorable outcome.
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Lowenthal et al. (2014) conducted an observational in Severe pulmonary stenosis or pulmonary atresia with intact ventricular septum (n=22). Prenatal tricuspid to mitral valve (TV/MV) ratio >0.63 vs. TV/MV ratio ≤0.63 was evaluated on Postnatal tricuspid valve Z-score >-3 (AUC 0.94, p=0.002). A fetal tricuspid to mitral valve ratio >0.63 strongly predicted a favorable postnatal tricuspid valve Z-score >-3 with an AUC of 0.94, 78% sensitivity, and 100% specificity.
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