J Am Heart Assoc. 2025 Jul 17:e041677. doi: 10.1161/JAHA.125.041677. Online ahead of print.
ABSTRACT
BACKGROUND: Case series report high mortality after fetal diagnosis of moderate to severe mitral regurgitation in combination with left atrial dilation, hydrops, or restrictive atrial septum. However, overall outcomes and specific high-risk features remain unclear.
METHODS: We performed a multicenter retrospective cohort study of fetuses with ≥moderate mitral regurgitation and normal cardiac connections evaluated January 1, 2005 to January 31, 2016. Fetuses undergoing fetal cardiac intervention (FCI) were described separately. We assessed associations between fetal echocardiographic features and discharge mortality using mixed logistic regression and classification and regression tree modeling, stratified by studies performed <28 and ≥28 weeks gestational age (GA).
RESULTS: Of 67 fetuses, 96% had aortic valve stenosis or atresia. Among the non-FCI group, fetal and discharge mortality was 10% (5/51) and 55% (28/51), respectively. For echocardiograms performed <28 weeks GA, only restrictive atrial septum (odds ratio [OR], 49.6 [95% CI, 5.6-437.5]) and earlier GA at referral (OR 0.72 per increasing week GA [95% CI 0.54-0.96]) remained associated in multivariable analysis. For those ≥28 weeks GA, in multivariable analysis, left atrial dilation (OR, 12.41 [95% CI, 2.19-70.33]) and lower ascending aortic Z score (OR per 1 unit increase, 0.61 [95% CI, 0.39-0.94]) remained in the model. By classification and regression tree modeling, left atrial dilation, restrictive atrial septum, and ascending aortic Z score <-1.3 were the key discriminators between survivors and nonsurvivors. Most FCIs were aortic valvuloplasty (13/16). Discharge mortality among FCI fetuses was 38%, not significantly different from non-FCI once adjusting for mitral regurgitation and LA dilation.
CONCLUSIONS: Fetal ≥moderate MsR is associated with high mortality. Left atrial dilation, restrictive atrial septum, and smaller ascending aorta confer highest risk for mortality.
PMID:40673509 | DOI:10.1161/JAHA.125.041677
