Abstract 18926: Late Gestation Predictors of Biventricular Outcome After Fetal Aortic Valvuloplasty
Background: Fetal aortic valvuloplasty (FAV) has shown promise in averting progression of mid-gestation aortic stenosis to hypoplastic left heart syndrome at birth. Late gestation predictors of biventricular circulation (BiV) after FAV are not known.
Methods: Between 2000 and August 2015, 122 fetuses underwent FAV. We evaluate late gestation fetal factors associated with BiV circulation in cases who returned for 3rd trimester imaging (n=81).
Results: Of the 81 patients included, 70 (86%) had a technical successful FAV at median gestational age of 23.7 weeks (range 20.2-31.0). Median age at late gestation echo was 35.4 weeks (29.7 -38.7) and duration between FAV and last echo was 2.3 months (1.0 to 3.9). BiV outcome occurred in 34 (42%) patients. Prior to FAV, all fetuses had retrograde flow in the transverse aortic arch and the majority (75%) had exclusively right to left PFO flow with the remainder having bidirectional flow (16%) or intact atrial septum (9%). At late gestation imaging, 49 % had anterograde aortic arch flow (p<0.001 compared to pre-FAV) and PFO flow direction was bidirectional in 30 % and entirely right to left in 64% (p=NS compared to pre-FAV).
Late gestation physiological factors associated with BiV outcome after FAV were higher LV pressure (median of 72 mm Hg in BiV vs. 37 mm Hg in single ventricle, p=0.002), anterograde flow through the aortic arch (90% of BiV vs. 30% of univentricular had anterograde flow, p< 0.001), bidirectional PFO flow (44% vs. 20%, p=0.04), and higher LV ejection fraction (43% vs. 26%, p=0.008). Anatomic factors associated with BiV outcome were higher z-scores for aortic valve (-2.8 vs. -3.9, p<0.001), ascending aorta (0.6 vs. -1.2, p<0.001), mitral valve (-2.3 vs -3.4, p<0.001), LV end-diastolic volume (-0.6 vs. -3.0, p=0.004) and LV long axis dimension (-0.9 vs. -2.6, p<0.001).
In multivariate analysis, anterograde flow in transverse aortic arch (HR = 60.7 [6.9-99.9] p=0.007), higher LV pressure (HR =1.48 [1.0-2.2], p=0.05), and higher LV long axis z-score (HR =3.1 [1.4-7.1], p=0.006) were independently associated with BiV outcome.
Conclusion: BiV outcome after FAV is associated with better LV performance in late gestation evidenced by higher LV pressure and anterograde through aortic arch as well as a longer LV.
Author Disclosures: K.G. Friedman: None. M. Drogosz: None. L. Wilkins-Haug: None. C. Benson: None. W. Tworetzky: None. A.C. Marshall: None.
- © 2016 by American Heart Association, Inc.