Left Ventricle to Right Ventricle Size Discrepancy in the Fetus: The Presence of Critical Congenital Heart Disease Can Be Reliably Predicted

Background

Prenatal ventricular size discrepancy with disproportionately smaller left ventricle than right ventricle (L-R/VD) can be a marker for important left-sided structural heart disease in the newborn.

Methods

We reviewed the echocardiograms of all fetuses evaluated at our center with L-R/VD from July 1, 2004 to January 1, 2008.

Results

Of the 35 fetuses, 20 (57%) had critical arch obstruction and underwent neonatal intervention (group 1); 15 (43%) did not require newborn intervention (group 2). Ratios comparing left with right heart structures were significantly lower in group 1 fetuses compared with group 2 fetuses. Aortic arch measurement ≤ 3 mm was the most sensitive, and abnormal direction of atrial level shunting was the most specific measure to predict the need for neonatal aortic arch intervention.

Conclusion

Ratios expressing the magnitude of L-R/VD, direction of flow at the atrial septum, and measurements of the aortic arch help identify fetuses that will require neonatal intervention.

Keywords: Aortic arch, Coarctation, Congenital heart disease, Echocardiogram, Fetal