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KMID : 0877920090110030119
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Korean Journal of Ultrasound in Obstetrics and Gynocology
2009 Volume.11 No. 3 p.119 ~ p.130
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Fetal Echocardiographic Markers Predicting the Prognosis of Tetralogy of Fallot
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Beak Su-Jin
Won Hye-Sung
Shim Jae-Yoon
Lee Pil-Ryang
Kim Ahm
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Abstract
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Objective: Tetralogy of Fallot (TOF) is a cyanotic congenital heart anomaly that composed of ventricular septal defect, pulmonary valvular stenosis or atresia, overriding aorta and right ventricular hypertrophy. Tetralogy of Fallot consisted about 10% of congenital cyanotic heart disease. But little is known about the natural history, neonatal anatomy and factors predicting the prognosis of TOF. The objective of this study was to identify fetal echocardiographic markers associated with the perinatal outcomes TOF for antenatal care and counseling.
Methods: Between March 2000 and May 2007, 140 fetuses diagnosed with TOF, including those with pulmonary atresia were studied retrospectively. Details of the echocardiographic findings, gestational age of diagnosis, maternal age, birth weight,extracardiac abnormalities, karyotype and outcome were reviewed. We evaluated ICU days and ventilator use as short-term outcome, and death, postoperative complication, reoperation as long-term outcome. There were analyzed by using SPSS 12.0.
Results: The mean gestational age at diagnosis was 26.4±5.3weeks. Of 94 fetuses with chromosomal analysis, 14 had anomalies, including 22q11 microdeletion in 6 fetuses and trisomy 21 in 7 fetuses. There were additional extracardiac malformations in 17/140 cases and additional cardiac malforations in 18. The parents of 13 cases choes the termination of pregnancy. Seventy one were alive, giving an average follow-up time of 771.5±710 days (14 to 2430), and 4 deaths occurred. Mean ICU stays was 22.9±28.6 days (2 to 167). Of 71 live-born fetuses, 55 patients at our clinic underwent surgery to correct tetralogy of Fallot. A total correction had been performed in 46 patients and a palliative shunt had been performed in 9 patients. Preterm birth, low birth weight, low Apgar score and combine anomaly were risk factors for outcome in clinical characteristics. There was a highly significant correlation between pregnancy outcomes and pulmonary valve (PV) velocity or pulmonary valve size ratio in fetal echocardiographic findings (r=-.309, p<0.031: r=.380, p<0.008, Pearson’s correlation coefficient). Cut-off values of PV size and PV velocity derived from receiver-operating characteristic curves yielding the best sensitivity and specificity for postnatal outcome were 0.631 , 1.22 (m/sec).
Conclusion: In the TOF with mild PS, preterm birth, low birth weight, low apgar score, combined anomaly, PV size and velocity in echocardiography were associated with postnatal outcome statistically. These findings would have important implications for prenatal counseling and predicting the postnatal outcome of TOF.
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KEYWORD
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Tetralogy of Fallot, Prenatal diagnosis, Fetal echocardiography
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