Table 1.

Previous and Current Selection Guidelines for Fetal Aortic Valvuloplasty

1. Dominant cardiac anatomic anomaly is valvar AS with all of the following

Decreased mobility of valve leaflets

Antegrade Doppler color flow jet across aortic valve smaller than the valve annulus diameter

No or minimal subvalvar LV outflow obstruction

2. Evolving HLHS

LV function qualitatively depressed AND EITHER Retrograde or bidirectional flow in the transverse aortic arch (between the first 2 brachiocephalic vessels) at any time during the cardiac cycle OR two of the following: Monophasic MV inflow (Doppler profile of MV inflow without discrete E and A waves) Left-to-right flow across atrial septum or intact atrial septum (bulging left to right) Bidirectional flow in pulmonary veins

3. Potential for a technically successful procedure and biventricular outcome postnatally

Criteria used for most of the patients in the present study (all 3 of the following)

LV long-axis Z score ≥−2

LV function qualitatively depressed but generating at least a 10 mm Hg pressure gradient across aortic valve or 15 mm Hg MR jet gradient

MV diameter Z score >−3

Modified criteria based on the findings of the present study

Unequivocal AS (vs aortic atresia)

LV long-axis Z score >−2

Threshold score ≥4 (≥4 of the following)

LV long-axis Z score >0

LV short-axis Z score >0

Aortic annulus Z score >−3.5

MV annulus Z score >−2

MR or AS maximum systolic gradient ≥20 mm Hg