PRENATAL-DIAGNOSIS OF SEVERE AORTIC-STENOSIS

We sought to identify echocardiographic markers that might be useful f or managing fetuses with significant aortic stenosis. The study was a retrospective review of fetal echocardiographic studies and postnatal outcomes of all fetuses diagnosed with significant aortic stenosis who did not have a hypoplastic left ventricle on the initial echocardiogr am. Where possible, fetal echocardiographic measurements included the aortic, mitral, pulmonary, and tricuspid valve annulus sizes; left ven tricular dimensions and volume; septal and left ventricular wall thick nesses; and echocardiographic Doppler interrogation of the left heart and oval fossa. Observations also included an assessment of ascites, p ericardial effusion, and endocardial fibroelastosis. Prenatal measurem ents were compared to postnatal outcomes. Four patients (group 1) had either clinically successful relief of their aortic obstruction (n = 3 ) or required no intervention (n = 1). Five fetuses evolved to the hyp oplastic left heart syndrome (group 2). These infants demonstrated lit tle or no growth in left ventricular, aortic valve, or mitral valve di mensions on serial examination. They also more often exhibited mitral stenosis, severe restriction of interatrial shunting, and early to mid second trimester left ventricular dilatation. Serial measurements of fetal cardiac size and function are helpful for predicting the postnat al outcome of fetuses with aortic stenosis.