OC09.03: Speckle tracking echocardiography in fetal pulmonary valve stenosis improves the detection of neonatal valvuloplasty

To evaluate a prediction model of neonatal valvuloplasty by fetal echocardiography including speckle tracking echocardiography in a series of isolated pulmonary stenosis. A prospective cohort study was conducted at BCNatal including fetuses with pulmonary valve stenosis (PS) and healthy controls. 2D echocardiography and off-line speckle tracking echocardiography were performed at the time of diagnosis. Echocardiographic parameters were analysed according to the need for neonatal valvuloplasty to identify possible predictors of early intervention. Twenty-four PS-fetuses (7 critical and 17 mild-moderate) were matched with 48 healthy controls by gestational age at echocardiography (32.5 (27.4-35.4) weeks). Half of the PS fetuses required valvuloplasty within the first month of life. Ductus venosus pulsatility index centile (cut-off value ≥79), right ventricle global longitudinal strain (cut-off value of ≥15.9%), reversed flow in the ductus arteriosus, and significant tricuspid regurgitation were predictors of neonatal valvuloplasty, and when combined in a scoring system the area under the curve was 0.931. Giving a score of 1 for each present variable, values >=2 predicted the need of neonatal valvuloplasty with a sensitivity of 91.7% and specificity of 100%. A scoring system combining the ductus venosus pulsatility index centile and right ventricle global longitudinal strain with the presence of reversed ductus arteriosus flow and significant tricuspid regurgitation, identifies more than 90% of the fetuses requiring a neonatal valvuloplasty in the first month of life with a specificity of 100%. Further studies are needed to confirm these results.