Pediatric Cardiology and Cardiac Surgery
Vol.26 No.2 2010 (113-118)
Mio Taketazu,1) Yoichi Iwamoto,1) Hirotaka Ishido,1) Satoshi Masutani,1) Hideaki Senzaki,1) Toshiki Kobayashi,1) Mika Iwazaki,2) Ayumu Masuoka,2) Takaaki Suzuki,2) and Toshiyuki Katogi2)
Departments of 1)Pediatric Cardiology, 2)Pediatric Cardiac Surgery, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
Background: Fetal atrioventricular valve regurgitation (AVVR) of the pulmonary ventricle can be ameliorated by the fall in pulmonary vascular resistance after birth. In contrast, fetal AVVR of a systemic ventricle may increase after birth due to the disruption of the placental circulation. The purpose of this study is to evaluate the postnatal outcome of fetal systemic AVVR.
Methods: Twenty-seven fetuses diagnosed with systemic AVVR at Saitama Medical University since 2002 were identified, and the relationship between the severity of the AVVR and the clinical outcome of the affected fetuses was evaluated. AVVR severity was classified into Grades I – IV by color flow mapping.
Results: At the first prenatal examination, 11 fetuses had Grade I AVVR, six had Grade II, four had Grade III, and four had Grade IV. The severity of AVVR in three fetuses changed prenatally, and two fetuses died in utero. In addition, AVVR appeared at late gestation in two fetuses that did not have AVVR at the first examination. The final prenatal examination showed 13 fetuses with Grade I, five with Grade II, four with Grade III, and three with Grade IV. There were no significant differences in clinical characteristics or cardiac morphologies among the fetuses with Grade I, II, or >III AVVR. Among the 13 fetuses with Grade I AVVR at the last prenatal examination, 12 fetuses did not require surgical intervention, and one with a corrected transposition of the great arteries required pulmonary artery banding because of advanced AVVR. Among the fetuses with Grade II, two did not require surgical intervention, and three required valvuloplasty at infancy or at early childhood. Among the seven with Grade III or IV, three died soon after birth, and three died after surgical valvuloplasty in the neonatal period. Only one with severe aortic valve stenosis survived because of a balloon aortic valvuloplasty performed at birth.
Conclusion: Fetuses with systemic AVVR higher than Grade II often worsened after birth and needed surgical intervention. Fetuses with AVVR higher than Grade III were critically ill after birth. They often needed emergency surgical intervention and had poor outcomes.