Clinical InvestigationValvular and Congenital Heart DiseaseBorderline left ventricles in prenatally diagnosed atrioventricular septal defect or double outlet right ventricle: Echocardiographic predictors of biventricular repair
Section snippets
Patient inclusion criteria
A bLV was defined as an RV/LV end-diastolic diameter ratio between 2 and 4 SDs for gestational age.18 All cases of unbalanced AVSD or DORV with a hypoplastic LV diagnosed in the fetus from the Hospital for Sick Children, Toronto, Canada, were identified from the cardiac database between 1991 and 2004.
Patient exclusion criteria
Cases were excluded if the AVSD or DORV was associated with mitral or aortic atresia, intact ventricular septum, hypoplastic pulmonary arteries, a heterotaxy syndrome, total anomalous pulmonary
Results
Between 1991 and 2004, 1481 fetuses were diagnosed with structural congenital heart disease at the Hospital for Sick Children. Of those, a total of 152 (10%) and 77 (5%) fetuses were diagnosed with AVSD and DORV, respectively. Of the 151 cases of AVSD, 27 (18%) were found to have a bLV, and of the 78 cases of DORV, 27 (34%) had a bLV. Six of these cases were excluded from the analysis including 2 with severely hypoplastic pulmonary arteries and 4 for different postnatal diagnoses (1 VSD and
Discussion
Fetal echocardiography has evolved significantly with both improvements in image resolution and the diagnosis of most forms of congenital heart disease. We are now beginning to focus on details that will accurately predict the outcome of affected pregnancies to provide appropriate and accurate counseling and plan for perinatal management. One of the most critical limitations encountered in this field is the ability to predict when a bLV is going to be sufficient to sustain the systemic
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Cited by (0)
- c
Current affiliation: Division of Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
- d
Current affiliation: Fetal Cardiovascular Program, Pediatric and Fetal Treatment Centers, University of California, San Francisco, CA.