Journal article
Authors list: Wolter, Aline; Markert, Natalia; Wolter, Jan Sebastian; Kurkevych, Andrii; Degenhardt, Jan; Ritgen, Jochen; Stressig, Rudiger; Enzensberger, Christian; Bedei, Ivonne; Vorisek, Carina; Schenk, Johanna; Graupner, Oliver; Khalil, Markus; Thul, Josef; Jux, Christian; Axt-Fliedner, Roland
Publication year: 2021
Pages: 81-90
Journal: Archives of Gynecology and Obstetrics
Volume number: 304
Issue number: 1
ISSN: 0932-0067
eISSN: 1432-0711
Open access status: Hybrid
DOI Link: https://doi.org/10.1007/s00404-020-05929-0
Publisher: Springer
Abstract:
Objectives To analyse prenatal parameters predicting biventricular (BV) outcome in pulmonary atresia with intact ventricular septum/critical pulmonary stenosis (PAIVS/CPS). Methods We evaluated 82 foetuses from 01/08 to 10/18 in 3 centres in intervals 1 (< 24 weeks), 2 (24-30 weeks) and 3 (> 30 weeks). Results 61/82 (74.4%) were livebirths, 5 (8.2%) lost for follow-up, 3 (4.9%) had compassionate care leaving 53 (64.6% of the whole cohort and 86.9% of livebirths) with intention to treat. 9 died, 44/53 (83.0%) survived. 24/38 (63.2%) with information on postnatal outcome had BV outcome, 14 (36.8%) non-BV outcome (2 x 1.5 circulation). One with BV outcome had prenatal valvuloplasty. Best single parameter for BV outcome was tricuspid/mitral valve (TV/MV) ratio (AUC 0.93) in intervals 2 and 3 (AUC 0.92). Ventriculo-coronary-arterial communications (VCAC) were present in 11 (78.6%) in non-BV outcome group vs. 2 (8.3%) in BV outcome group (p < 0.001). Tricuspid insufficiency (TI)-Vmax > 2.5 m/s was present in BV outcome group in75.0% (18/24) vs. 14.3% (2/14) in non-BV outcome group. Including the most predictive markers (VCAC presence, TI- Vmax < 2.5 m/s, TV/MV ratio < cutoff) to a score, non-BV outcome was correctly predicted when > 1 criterion was fulfilled in all cases. After recently published criteria for foetal intervention, only 4/9 (44.4%) and 5/14 (35.7%) in our interval 2 + 3 with predicted non-BV outcome would have been candidates for intervention. Two (1 x intrauterine intervention) in interval 2, two in interval 3 reached BV outcome and one 1.5 circulation without intervention. Conclusion TV/MV ratio as simple parameter has high predictive value. After our score, non-BV outcome was correctly predicted in all cases. Criteria for foetal intervention must further be evaluated.
Citation Styles
Harvard Citation style: Wolter, A., Markert, N., Wolter, J., Kurkevych, A., Degenhardt, J., Ritgen, J., et al. (2021) Natural history of pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS) and prediction of outcome, Archives of Gynecology and Obstetrics, 304(1), pp. 81-90. https://doi.org/10.1007/s00404-020-05929-0
APA Citation style: Wolter, A., Markert, N., Wolter, J., Kurkevych, A., Degenhardt, J., Ritgen, J., Stressig, R., Enzensberger, C., Bedei, I., Vorisek, C., Schenk, J., Graupner, O., Khalil, M., Thul, J., Jux, C., & Axt-Fliedner, R. (2021). Natural history of pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS) and prediction of outcome. Archives of Gynecology and Obstetrics. 304(1), 81-90. https://doi.org/10.1007/s00404-020-05929-0
