Absent Pulmonary Valve Syndrome – Special Prenatal Care and Early Surgery in Obstetric/Cardiac Center - A New Hope for Postnatal Survivors?

Abstract

Introduction: APVS (Absent Pulmonary Valve Syndrome) is a rare congenital heart disease. Its incidence according to The Polish National Registry of Fetal Cardiac Pathology in years 2004 - 2016 was 0.6%.This disease is caused by the absence or the residual pulmonary artery valve resulting in significant dilation of the pulmonary trunk and its branches. In utero deaths are reported. After birth the major problem is respiratory failure and high preoperative and postoperative mortality. Material and methods: In 1995 to 2016, 11 fetuses with APVS were diagnosed in our unit, at the average 27,5 weeks of gestation (min. 18.5- max 37.1 weeks of gestation). Two groups were analysed in this series of cases: “Old one” by 2011 (n = 6) and “New one” since 2011 (n = 5) and perinatal care as well as survival were compared. We analysed the fetal echo results, perinatal care including transplacental digoxin and steroids treatment in NEW group, the longevity of the pregnancy and neonatal/infants outcome. Results: In Old group the average day of cardiac surgery was day 91st after birth (max. 161) and the survival was 50% . In the New group the average surgery day was 41st day and the postoperative survival was 60%, however there was no statistical significance ( p > 0,05). Conclusions: There is no single parameter from prenatal life in foetuses with APVS which may allow to predict the positive outcome meaning neonatal survival. However optimal perinatal care (early detection of defect, transplacental digoxin at least 3-4 weeks, steroids, no preterm delivery, on-time delivery, postnatal care in tertiary center) and relatively early cardiac surgery may have combined impact on the improvement of survival after prenatal diagnosis of APVS, however more data are necessary to prove this hypothesis.

Prenatal dilatation of the pulmonary artery in the third trimester – important information for paediatric cardiologist or for neonatologist? Case report

“…• A dilated MPA in the three-vessel-view in tetralogy of Fallot with absent pulmonary valve syndrome with to and fro blood flow and patterns of severe stenosis and insufficiency of the pulmonary valve • Width of MPA does not correlate with the survival of the newborns with APVS, but affects the respiratory tract compression and respiratory dysfunction, probably secondary to the pulmonary valve regurgitation, seen prenatally [3][4][5][6][7][8][33][34][35][36] Ductal constriction • Constriction of fetal ductus arteriosus is a risk factor for pulmonary hypertension in the newborn period with known severe consequences [37][38][39][40][41][42] Pulmonary hypertension/congenital diaphragmatic hernia (CDH), liver herniation (LV)…”