[II-AEPCYIA-4] Postinterventional fetal aortic regurgitation: good or bad?
Keywords:Fetal Cardiac Interventions, Fetal Aortic Valvuloplasty, Critical Aortic Stenosis, Aortic Regurgitation
BACKGROUND AND AIM:Aortic valve regurgitation (AR) may occur in fetuses with critical aortic stenosis (CAS) after a successful effective aortic valvuloplasty (AV). Prenatal improvement of AR has been reported, but not systematically studied. The aim of this study is to assess the postinterventional incidence of AR in fetuses with CAS, the degree of in-utero aortic valve remodeling and its effect on prenatal LV growth.
METHOD:This is a retrospective study of all fetuses who underwent AV due to CAS at our center. Only fetuses with an available postnatal echocardiogram were included. Echocardiograms were reviewed on the first or second post-interventional day and the day of birth for AR severity, LV size and function and related to the balloon to aortic valve ratio. The degree of AR was analyzed by two experienced observers and defined as none/trivial, mild, moderate or severe based on the duration and extent of the AR jet and amount of retrograde flow in the aortic arch.
RESULTS:Between 2001 and October 2023, 135 fetuses underwent 165 FAV at our institution. Postinterventional and postnatal echocardiograms were available for 61 patients. The incidence of AR is shown in Table 1. Fifty two fetuses (85%) showed variable degrees of AR directly after FAV. Balloon/valve ratios were significantly higher in moderate/severe AR fetuses (median: 1,09 (0.81-1.23) vs. 1,00 (0.85-1.18), p=0.0003). At birth, the number of patients showing some degree of AR decreased to 52% (p<0.0001). Fetuses with moderate/severe AR directly after FAV showed improved relative LV growth until birth compared to no/mild AR fetuses (median LV length-gain 23.2% vs. 11.6%, p=0.040).
CONCLUSIONS:Fetal AV led to AR in most patients. Higher degrees of AR were associated with larger balloon to aortic valve ratios and were well tolerated. Significant improvement of AR severity up to complete resolution is possible in prenatal life. More than mild AR was associated with improved LV development. Care should be taken to choose a large enough balloon (>=110% of the valve diameter) to effectively dilate the aortic valve. More than mild AR seems to be beneficial without precluding an eventual postnatal univentricular pathway.
METHOD:This is a retrospective study of all fetuses who underwent AV due to CAS at our center. Only fetuses with an available postnatal echocardiogram were included. Echocardiograms were reviewed on the first or second post-interventional day and the day of birth for AR severity, LV size and function and related to the balloon to aortic valve ratio. The degree of AR was analyzed by two experienced observers and defined as none/trivial, mild, moderate or severe based on the duration and extent of the AR jet and amount of retrograde flow in the aortic arch.
RESULTS:Between 2001 and October 2023, 135 fetuses underwent 165 FAV at our institution. Postinterventional and postnatal echocardiograms were available for 61 patients. The incidence of AR is shown in Table 1. Fifty two fetuses (85%) showed variable degrees of AR directly after FAV. Balloon/valve ratios were significantly higher in moderate/severe AR fetuses (median: 1,09 (0.81-1.23) vs. 1,00 (0.85-1.18), p=0.0003). At birth, the number of patients showing some degree of AR decreased to 52% (p<0.0001). Fetuses with moderate/severe AR directly after FAV showed improved relative LV growth until birth compared to no/mild AR fetuses (median LV length-gain 23.2% vs. 11.6%, p=0.040).
CONCLUSIONS:Fetal AV led to AR in most patients. Higher degrees of AR were associated with larger balloon to aortic valve ratios and were well tolerated. Significant improvement of AR severity up to complete resolution is possible in prenatal life. More than mild AR was associated with improved LV development. Care should be taken to choose a large enough balloon (>=110% of the valve diameter) to effectively dilate the aortic valve. More than mild AR seems to be beneficial without precluding an eventual postnatal univentricular pathway.