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Updated: May 14, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
A predictive index for the need for neonatal surgical intervention in severe Ebstein's disease
Shinichiro Sakaki1, Shin Ono1, Naka Saito2
1Department of Cardiology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
Insights
The systolic/diastolic time ratio, calculated from echocardiography at birth, can predict the need for neonatal surgery in severe Ebstein's disease patients. A ratio below 2 suggests monitoring without immediate surgical intervention.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Severe Ebstein's disease often requires early neonatal surgery, but indicators for this critical decision are lacking.
- Existing indicators focus on circulatory potential, not immediate surgical necessity.
Purpose of the Study:
- To identify predictive indices for neonatal surgical intervention in severe Ebstein's disease.
- To analyze clinical and laboratory characteristics differentiating neonates requiring surgery from those managed medically.
Main Methods:
- Retrospective analysis of eight severe Ebstein's disease patients (2018-2023).
- Comparison of clinical courses and laboratory indices between neonates who underwent surgery (Group S) and those who did not (Group F).
- Calculation of the systolic/diastolic time ratio from the tricuspid regurgitation waveform on echocardiography at birth.
Main Results:
- The systolic/diastolic time ratio was significantly prolonged in Group S (2.18 ± 0.31) compared to Group F (1.72 ± 0.20) (p=0.043).
- A threshold ratio of 1.99 demonstrated 100% sensitivity and 75% specificity for predicting neonatal surgery necessity (AUC=0.94).
Conclusions:
- The systolic/diastolic time ratio is a valuable predictive index for ventricular function and prognosis in severe Ebstein's disease.
- A systolic/diastolic time ratio <2 at birth may guide non-surgical management through the newborn period.
Abstract:
Severe Ebstein's disease often necessitates early neonatal surgical intervention, although, in some patients, surgery may be delayed until infancy or later, and medical management may be undertaken instead. Various indicators, such as tricuspid regurgitation flow velocity, have been studied to predict single or biventricular circulation; however, indicators predicting the need for neonatal surgery have not been addressed. We aimed to identify predictive indices for neonatal surgical necessity by analysing the clinical characteristics of those requiring and not requiring neonatal surgery. We enrolled eight patients with severe Ebstein's disease who were born at our hospital from 2018 to 2023. Four patients underwent neonatal surgery (Group S), whereas four did not (Group F). We compared pregnancy, delivery, and postnatal clinical courses and laboratory indices before and after birth between the groups. The systolic/diastolic time ratio, an index of ventricular function calculated from the TR waveform of echocardiography at birth, was significantly prolonged in Group S [2.18 ± 0.31 vs. 1.72 ± 0.20 in Group F (p = 0.043)]. The area under the receiver operating characteristic curve was 0.94, with a threshold systolic/diastolic time ratio value of 1.99 using Youden's method. This ratio predicted neonatal surgery necessity with 100% sensitivity and 75% specificity. Despite the small sample size, we demonstrated that the systolic/diastolic time ratio is a valuable predictive index of ventricular function and prognosis in severe Ebstein's disease patients. A systolic/diastolic time ratio <2, determined from the tricuspid regurgitation waveform on echocardiography at birth, supports patient monitoring without surgical intervention through the newborn period and beyond.
