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Extracardiac Doppler indices predict perinatal mortality in fetuses with Ebstein anomaly and tricuspid valve dysplasia
Author(s) -
Wang Shuo,
Freud Lindsay R.,
Detterich Jon,
MoonGrady Anita J.,
Donofrio Mary T.,
Jaeggi Edgar T.,
Szwast Anita L.,
Morris Shaine A.,
KavanaughMchugh Ann,
Howley Lisa W.,
Velde Mary E.,
Cuneo Bettina F.,
Phoon Colin K.,
Tworetzky Wayne,
Pruetz Jay D.
Publication year - 2021
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.5873
Subject(s) - ductus venosus , medicine , cardiology , tricuspid valve , umbilical artery , fetus , obstetrics , pregnancy , genetics , biology
Objectives Ebstein anomaly and tricuspid valve dysplasia (EA/TVD) carry high perinatal mortality. Past studies have focused on cardiac predictors of mortality; we sought to describe the fetal echo (FE) extracardiac Dopplers in this cohort and determine their association with perinatal mortality. Method Fetuses with EA/TVD at 23 centers from 2005–2011 were included for retrospective study. Doppler pattern and velocity of the umbilical artery (UA), umbilical vein (UV), ductus venosus (DV), and middle cerebral artery (MCA) were collected. Bivariate and multivariate analyzes were performed. The primary outcome measure was perinatal mortality, defined as fetal demise or neonatal death. Results Of 190 cases that met eligibility criteria, alterations were seen in 50% of UA, 16% of UV, 48% of DV, and 8% of MCA Doppler indices on the last FE (median 27.4 weeks). Independent predictors of perinatal mortality included abnormal UA Doppler pattern of absence or reversed end diastolic flow (OR 9.7) and UV velocity z score <1 (OR 2.5), in addition to diagnosis <32 weeks (OR 4.2) and tricuspid valve (TV) annulus z score ≥6 (OR 5.3). Conclusion Abnormal UA Doppler pattern and decreased UV velocity are independent predictors of perinatal mortality in EA/TVD fetuses and should be used to refine mortality risk and guide perinatal management.