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Pulmonary venous Doppler patterns and midterm outcomes in fetuses with left‐sided obstructive lesions and restrictive atrial septum
Author(s) -
Schneider Kristin,
Hahn Eunice,
Statile Christopher,
Hirsch Russel,
Khoury Philip R.,
Cnota James,
Divanovic Allison
Publication year - 2020
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.5682
Subject(s) - medicine , retrospective cohort study , neonatal intensive care unit , cohort , fetus , intensive care unit , hypoplastic left heart syndrome , cardiology , surgery , pediatrics , pregnancy , heart disease , biology , genetics
Objective To compare length of stay of the initial neonatal hospitalization and mortality across multiple stages of surgical palliation for infants with left‐sided obstructive lesions and severely restrictive or intact atrial septum (I/RAS). Methods Retrospective cohort study of patients prenatally diagnosed with left‐sided obstructive lesions and I/RAS, defined by fetal pulmonary venous Dopplers. Results We identified 76 fetal patients with 59 live born intending to pursue intervention. Those with I/RAS had longer durations of mechanical ventilation ( P = .031) but no difference in intensive care unit or total length of stay. Survival to discharge from neonatal hospitalization was 41.7% in the I/RAS group and 80.7% in the unrestrictive group ( P = .001). There was a higher proportion of deaths between stage 1 and stage 2 in the I/RAS group ‐ 5/9 (55.6%) vs 9/50 (18%) in the unrestrictive group ( P = .027). Beyond stage 2 palliation there was trend toward a difference in overall mortality (66.7% in I/RAS vs 35.7% in unrestrictive, P = .05) but no statistically significant difference in transplant‐free survival (33.3% in I/RAS vs 53.5% in unrestrictive, P = .11). Conclusion The survival disadvantage conferred by prenatally diagnosed severe atrial septal restriction is most pronounced in the neonatal and early infancy period, with no detectable difference in late midterm transplant‐free survival in our cohort.