Prenatal Predictors for Pulmonary Balloon Valvuloplasty in the Newborn

Area of Science:

• Pediatric Cardiology
• Fetal Echocardiography
• Congenital Heart Disease

Background:

• Isolated pulmonary stenosis (IPS) is a congenital heart defect.
• Pulmonary balloon valvuloplasty (PBV) is the primary treatment for IPS.
• Predicting the need for early intervention is crucial for optimal infant care.

Purpose of the Study:

• To identify fetal echocardiographic predictors of inpatient PBV in newborns with IPS.
• To characterize resource utilization for fetuses with IPS across multiple centers.
• To inform decisions regarding delivery site for pregnancies complicated by fetal IPS.

Main Methods:

• Retrospective case series of 49 singleton fetuses with IPS (2010-2020).
• Analysis of third-trimester fetal echocardiogram data compared to postnatal outcomes.
• Statistical analysis including logistic regression, t-tests, and Chi-Square testing.

Main Results:

• 38 (78%) fetuses underwent inpatient PBV, 11 (22%) had outpatient PBV.
• Inpatient PBV was associated with third-trimester findings: abnormal ductus arteriosus flow (61%) and peak pulmonary valve velocity > 3.0 m/s (OR 16.9).
• These echocardiographic features demonstrated high sensitivity (90.4%) and specificity (97.7%) for predicting inpatient PBV.

Conclusions:

• Third-trimester fetal echocardiographic parameters, specifically ductus arteriosus flow direction and pulmonary valve peak velocity, can accurately predict the need for inpatient PBV.
• These findings may aid in selecting appropriate delivery locations for pregnancies with fetal IPS.
• Early identification of infants requiring inpatient PBV can optimize management and resource allocation.