Morphologic and Functional Predictors of Eventual Circulation in the Fetus With Pulmonary Atresia or Critical Pulmonary Stenosis With Intact Septum
Helena M. Gardiner, PhD, MD, FRCP*, ,*,
Cristian Belmar, MD*,
Gerald Tulzer, MD, PhD ,
Anna Barlow, BS*,,
Lucia Pasquini, MD*,
Julene S. Carvalho, PhD, FRCPCH, ,
Piers E.F. Daubeney, MRCP,
Michael L. Rigby, FRCP,
Fabiana Gordon, PhD||,
Elena Kulinskaya, PhD|| and
Rodney C. Franklin, FRCP
* Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College at Queen Charlotte’s and Chelsea Hospital, London, United Kingdom
Brompton Fetal Cardiology, Royal Brompton Hospital and the National Heart and Lung Institute, London, United Kingdom
Childrens’ Heart Centre, Linz, Austria
Fetal Medicine Unit, St. George’s Hospital, London, United Kingdom
|| Statistical Advisory Service, Imperial College, London, United Kingdom.
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Figure 1 Score Prediction of Post-Natal Circulation Before 23 Weeks’ Gestation
Score prediction before 23 weeks’ gestation using a cutoff of pulmonary valve (PV) z-scores >–1 and tricuspid valve (TV) z-scores >–3.4 to predict a biventricular (BV) rather than univentricular (UV) post-natal surgical pathway. Fetus 6 was seen twice, at 15 + 5 and 19 + 5 weeks’ gestation when the z-scores (6') were worse. Normal z-score ranges are between +2 and –2. Circles = score of 0; squares = score of 1.
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Figure 2 Score Prediction of Post-Natal Circulation Between 26 and 31 Weeks’ Gestation
Score prediction between 26 and 31 weeks’ gestation using median PV z-scores and mitral valve (MV) to tricuspid valve (TV) ratios to separate those assigned to a UV or BV post-natal pathway. The numbers in the figures refer to the individual cases, with boxes around the case number and a symbol identifying those who underwent a fetal intervention. Normal z-score ranges are between +2 and –2. Circles = score of 0; open squares = score of 1; solid squares = score of 2. Abbreviations as in Figure 1.
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Figure 3 Score Prediction of Post-Natal Circulation After 31 Weeks’ Gestation
Score prediction after 31 weeks’ gestation using median TV z-scores and MV/TV ratios to separate those assigned to a UV or BV post-natal pathway. The numbers in the figures refer to the individual cases, with boxes around the case number and symbol identifying those who underwent fetal intervention. Normal z-score ranges are between +2 and –2. Circles = score of 0; open squares = score of 1; solid squares = score of 2. Abbreviations as in Figures 1 and 2.
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Figure 4 Prediction of Circulation at <26 Weeks Combining Physiological and Morphologic Scores
Prediction of eventual circulation before 26 weeks’ gestation by combining the right atrial pressure (RAP) score and score using the median TV z-score (medTV z-score >–3.95). The numbers in the figures refer to the individual cases, with boxes around the case number and a symbol identifying those who underwent fetal intervention. Normal z-score ranges are between +2 and –2. Circles = score of 0; squares = score of 1. Abbreviations as in Figures 1 and 2.
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Figure 5 Serial TV z-Scores
Comparison of serial tricuspid valve (TV) z-scores for gestational age in the 3 fetuses undergoing valvuloplasty (bold lines) with the remainder of the cohort. Timing of intervention is marked with solid arrows. Normal z-score ranges are between +2 and –2 and are shaded.
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