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Prenatal Predictors for Pulmonary Balloon Valvuloplasty in the Newborn

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Abstract

Pulmonary balloon valvuloplasty (PBV) is the treatment of choice for subjects with isolated pulmonary valve stenosis (IPS). The purpose of this study was to define fetal echocardiographic features associated with an inpatient PBV prior to newborn hospital discharge and characterize resource utilization of IPS fetuses among participating centers. Six center, retrospective case series of singleton fetuses identified between 2010 and 2020 with IPS. Third-trimester echocardiogram data was compared with postnatal data, included pulmonary valve Doppler velocities, pulmonary valve insufficiency and ductus arteriosus flow direction. Comparison between subjects who underwent inpatient PBV during their newborn hospital admission versus those infants referred for outpatient PBV after initial hospital discharge. We analyzed data by logistic regression, student t test and Chi-Square testing with a p value of ≤ 0.05 considered statistically significant. Forty-nine IPS fetuses were identified. Thirty-eight (78%) underwent inpatient PBV at 5 (range 1–58) days and 11 (22%) underwent outpatient PBV at 51.8 (11–174) days. Newborns requiring an inpatient PBV were more likely to have one or more characteristics on 3rd-trimester fetal echocardiogram: left to right or bidirectional ductus arteriosus flow (61% vs 0%), and/or a peak pulmonary valve velocity > 3.0 m/s (odds ratio 16.9, 95% confidence interval 3.02–94.17) with a sensitivity of 90.4% and specificity of 97.7%. Ductus arteriosus flow direction and pulmonary valve peak velocity in the 3rd trimester can successfully predict the need for newborn inpatient PBV. We speculate these findings may be useful in choosing delivery site for the pregnancy complicated by fetal IPS.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Jennifer A. Johnson & Tarek Alsaied

  2. Obstetrics, Gynecology and Reproductive Sciences, UPMC Magee Womens Hospital, Pittsburgh, PA, USA

    Timothy Canavan

  3. Pediatric Cardiology, The Children’s Heart Clinic/Children’s Minnesota, Minneapolis, MN, USA

    Lisa Howley

  4. Pediatric Cardiology, Children’s Mercy Kansas City, Kansas City, MO, USA

    Hayley S. Hancock

  5. Pediatric Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Divya Suthar

  6. Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Elisa Marcuccio & Taylor M. Trussell

  7. Pediatric Cardiology, Children’s Hospital Colorado, Denver, CO, USA

    Bettina Cuneo

  8. Pediatric Cardiology, Methodist Children’s Hospital, San Antonio, TX, USA

    Jennifer A. Johnson

  9. Pediatric Cardiology, Mednax/Pediatrix, San Antonio, TX, USA

    Jennifer A. Johnson

Authors
  1. Jennifer A. Johnson
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  2. Timothy Canavan
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  3. Tarek Alsaied
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  4. Lisa Howley
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  5. Hayley S. Hancock
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  6. Divya Suthar
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  7. Elisa Marcuccio
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  8. Taylor M. Trussell
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  9. Bettina Cuneo
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JJ and TC. The first draft of the manuscript was written by JJ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jennifer A. Johnson.

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Johnson, J.A., Canavan, T., Alsaied, T. et al. Prenatal Predictors for Pulmonary Balloon Valvuloplasty in the Newborn. Pediatr Cardiol 45, 722–728 (2024). https://doi.org/10.1007/s00246-024-03430-y

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  • DOI: https://doi.org/10.1007/s00246-024-03430-y

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