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May 2, 2019Prenatal Diagnosis

Outcomes of hypoplastic left heart syndrome and fetal aortic valvuloplasty in a country with suboptimal postnatal management

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Key result

Fetal aortic valvuloplasty in fetuses with evolving hypoplastic left heart syndrome was associated with 44% postnatal survival, compared to a 2.6% survival rate in the HLHS cohort.

Why the study?

Data were lacking describing the survival of fetuses or neonates with AoS or HLHS in a country with suboptimal postnatal management.

Does fetal aortic valvuloplasty improve survival in fetuses with evolving hypoplastic left heart syndrome in a country with suboptimal postnatal management?

Comparison

Fetal aortic valvuloplasty for evolving HLHS vs standard postnatal management

Design

Prospective cohort study

Authors

MCM. Cruz‐LeminiMAMonica Alvarado‐GuamanBNB. Nieto‐Castro

Discussion

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Overview

HLHS survival <5% in Mexico; leaves open whether fetal valvuloplasty improves biventricular outcomes in similar low-resource settings.

Study Design

Type

Cohort (n=54)

Structured PICO

Does fetal aortic valvuloplasty improve survival in fetuses with evolving hypoplastic left heart syndrome in a country with suboptimal postnatal management?

P
Population
54 fetuses and neonates diagnosed with aortic stenosis or hypoplastic left heart syndrome in Mexico over a 6-year period.
E
Exposure
Fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome (eHLHS)
O
Outcome
Perinatal mortality, postnatal management, type of postnatal circulation, and overall survivalhard clinical

Main Result

Absolute Event Rate: 44% vs 2.6%

In a setting with suboptimal postnatal management, fetal aortic valvuloplasty for evolving HLHS is associated with approximately 44% survival, whereas established HLHS carries a >95% mortality rate.

Limitations

  • Small cohort size

Cite This Study

Cruz‐Lemini et al. (2019) conducted a cohort in Aortic stenosis and hypoplastic left heart syndrome (n=54). Fetal aortic valvuloplasty vs. No fetal intervention (HLHS cohort) was evaluated on Overall postnatal survival. Fetal aortic valvuloplasty in fetuses with evolving hypoplastic left heart syndrome was associated with 44% postnatal survival, compared to a 2.6% survival rate in the HLHS cohort.

synapsesocial.com/papers/6a9b8a4859527e0262c7e7dahttps://doi.org/10.1002/pd.5470
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Intrauterine aortic valvuloplasty in fetuses with critical aortic stenosis: experience and results of 24 procedures2011 · 137 citations
  2. 2Predictors of Technical Success and Postnatal Biventricular Outcome After In Utero Aortic Valvuloplasty for Aortic Stenosis With Evolving Hypoplastic Left Heart Syndrome2009 · 313 citations
  3. 3Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study2017 · 70 citations
  4. 4Development of <i>Z</i>‐scores for fetal cardiac dimensions from echocardiography2005 · 314 citations
  5. 5Diagnosis and Treatment of Fetal Cardiac Disease2014 · 1,257 citations