Ann C Chau1, Andrew Jones2, Monique Sutherland2, Christian Lilje3, Stefan Sernich3, Joseph Hagan4, Joseph Miller1. 1. Division of Maternal-Fetal Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA. 2. Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA. 3. Department of Pediatrics, Division of Pediatric Cardiology , Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA. 4. Texas Children's Hospital, Houston, Texas, USA.
Abstract
OBJECTIVES: To determine the characteristics of fetal ventricular septal defects (VSDs) that will be less likely to close prenatally. METHODS: In this 4-year retrospective cohort study, 148 fetuses had a diagnosis of a VSD during a comprehensive fetal anatomy survey. The VSD diagnosis was confirmed by color and pulsed wave Doppler studies. These fetuses were followed monthly until their birth. They had postnatal echocardiography performed within 1 month of age to assess the persistence of a VSD. Fisher exact, Wilcoxon rank sum, and log rank tests and bivariate and multivariate logistic regressions were used to examine the association of each individual variable with prenatal VSD closure. RESULTS: One hundred twenty-five of 148 fetuses (84%) had prenatal VSD closure at a mean gestational age ± SD of 26.9 ± 4.5 weeks. Fetuses with a persistent VSD more frequently had other cardiac defects than the closed VSD group (12 of 23 versus 5 of 125; P < .001). Fetuses having a persistent VSD more frequently had an abnormal karyotype (9 of 23 versus 5 of 125; P < .001). The persistent VSDs were larger in their initial size (5.9 ± 8.4 mm versus 2.7 ± 0.8 mm; P = .002) and in their maximal prenatal size (6.0 ± 9.1 mm versus 2.9 ± 0.9 mm; P < .001). The presence of associated cardiac defects (adjusted odds ratio = 0.071; P = .031) and an abnormal karyotype (adjusted odds ratio = 0.058; P = .021) were significantly associated with a lower likelihood of prenatal VSD closure. All VSDs with a maximal size of 2 mm or less closed prenatally. CONCLUSIONS: Fetuses with a complex cardiac defect or an abnormal karyotype were less likely to have prenatal VSD closure.
OBJECTIVES: To determine the characteristics of fetal ventricular septal defects (VSDs) that will be less likely to close prenatally. METHODS: In this 4-year retrospective cohort study, 148 fetuses had a diagnosis of a VSD during a comprehensive fetal anatomy survey. The VSD diagnosis was confirmed by color and pulsed wave Doppler studies. These fetuses were followed monthly until their birth. They had postnatal echocardiography performed within 1 month of age to assess the persistence of a VSD. Fisher exact, Wilcoxon rank sum, and log rank tests and bivariate and multivariate logistic regressions were used to examine the association of each individual variable with prenatal VSD closure. RESULTS: One hundred twenty-five of 148 fetuses (84%) had prenatal VSD closure at a mean gestational age ± SD of 26.9 ± 4.5 weeks. Fetuses with a persistent VSD more frequently had other cardiac defects than the closed VSD group (12 of 23 versus 5 of 125; P < .001). Fetuses having a persistent VSD more frequently had an abnormal karyotype (9 of 23 versus 5 of 125; P < .001). The persistent VSDs were larger in their initial size (5.9 ± 8.4 mm versus 2.7 ± 0.8 mm; P = .002) and in their maximal prenatal size (6.0 ± 9.1 mm versus 2.9 ± 0.9 mm; P < .001). The presence of associated cardiac defects (adjusted odds ratio = 0.071; P = .031) and an abnormal karyotype (adjusted odds ratio = 0.058; P = .021) were significantly associated with a lower likelihood of prenatal VSD closure. All VSDs with a maximal size of 2 mm or less closed prenatally. CONCLUSIONS: Fetuses with a complex cardiac defect or an abnormal karyotype were less likely to have prenatal VSD closure.
Authors: Annalisa Angelini; Cira di Gioia; Helen Doran; Marny Fedrigo; Rosa Henriques de Gouveia; Siew Yen Ho; Ornella Leone; Mary N Sheppard; Gaetano Thiene; Konstantinos Dimopoulos; Barbara Mulder; Massimo Padalino; Allard C van der Wal Journal: Virchows Arch Date: 2020-04-07 Impact factor: 4.064
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