Mats Mellander, NNFM Nordic Network of Fetal Medicine meeting in Gothenburg 14-16th of April 2015.

1. 6/11/2014 Oasis, The Online Abstract Submission System
http://www.abstractsonline.com/submit/SubmitPrinterFriendlyVersion.asp?ControlKey=%7BEFF9ED75%2DEF72%2D42A1%2D91DA%2D8ADD14E8E23A%7… 1/2
Print this Page for Your Records Close Window
Control/Tracking Number: 2014-SS-A-13233-AHA
Activity: Abstract
Current Date/Time: 6/11/2014 5:22:00 PM
Does Fetal Aortic Valvuloplasty alter the Natural History of Aortic Stenosis?
Author Block: Alexander Kovacevic, Imperial Coll London, London, United Kingdom; Mats Mellander, Queen Silva Children´s Hosp, Gothenburg, Sweden; Gerald Tulzer,
Childrens' Heart Ctr Linz, Linz, Austria; Ulrike Herberg, Children's Hosp, Univ Hosp of Bonn, Bonn, Germany; Joanna Dangel, Medical Univ of Warsaw, Warsaw, Poland;
Annika Öhman, Astrid Lindgren Children's Hosp, Stockholm, Sweden; Helena Gardiner, Univ of Texas at Houston, Houston, TX
Abstract:
Introduction: Fetal aortic valvuloplasty (FV) is proposed as therapy to achieve biventricular circulation (BV) in fetuses where univentricular circulation (UV) is likely.
Hypothesis: FV cannot alter natural history (NH) outcome.
Methods: Hybrid of case-control and repeated samples cohort study. Fetuses with aortic stenosis (AS) were enrolled in a multicenter study (2005-2012). FV was
considered in 70 / 214 AS and successful in 59/67 (88.0%) performed. Six salvage cases (hydrops) were excluded and 47 liveborn FV could be matched with 95 controls
(NH) by scan closest to 23 +/- 3 weeks and +/- 1 Z-score for MV, LV and AV, producing a best match group for each.
Results: Procedure-related death occurred in 7/67 (10.4%). Overall 151/214 (71%) were liveborn, but outcome unknown in 5. Serial left sided growth was similar in FV and
NH: Z score differences MV = 0.11, LV = 0.08, AV = 0.11, p>0.90. Hazard ratio for FV survival was similar to NH at 30 d, 1 and 4 yrs after birth [0.68 (95% CI 0.347 -
1.315), p= 0.25]. Cohorts matched for MV, LV and AV did not show survival advantage after FV and survival with freedom from UV circulation showed fewer BV survivors in
FV than NH. (Fig 1) Funnel plots show improved BV survival by center volume for FV, but more BV-UV conversions in one with limited surgical options where 17% vs 82%
FV remain BV. (Fig 2)
Conclusions: Data show no survival advantage or improved chance of BV at 4 years in fetuses matched for morphology at 23 wks undergoing FV. Centralization of FV may
improve survival, but BV - UV conversion suggests a specialized surgical approach is also essential to maintain BV outcome. A carefully designed prospective study is
indicated to better evaluate FV. procedure.
:
Author Disclosure Information: A. Kovacevic: None. M. Mellander: None. G. Tulzer: None. U. Herberg: None. J. Dangel: None. A. Öhman: None. H. Gardiner:
None.

2. 6/11/2014 Oasis, The Online Abstract Submission System
http://www.abstractsonline.com/submit/SubmitPrinterFriendlyVersion.asp?ControlKey=%7BEFF9ED75%2DEF72%2D42A1%2D91DA%2D8ADD14E8E23A%7… 2/2
American Heart Association
7272 Greenville Avenue
Dallas, Texas 75231
OASIS Helpdesk
Pow ered by OASIS, The Online Abstract Submission and Invitation System SM
© 1996 - 2014 Coe-Truman Technologies, Inc. All rights reserved.
Category (Complete): 305. Pediatric Congenital and Acquired Heart Disease
Keyword (Complete): Aortic valve stenosis ; Valvuloplasty ; Congenital heart disease
Presentation Preference (Complete): Oral or Poster
Additional Info (Complete):
*: E. Have Submitted in the Past
*: Yes
If yes, please select which primary council
: Cardiovascular Disease in the Young
*: No
*Disclosure: There are no unlabeled/unapproved uses of drugs or products.
*: Yes
Payment (Complete): Your credit card order has been processed on Monday 9 June 2014 at 10:38 AM.
Status: Complete