Retrospective case series examining the clinical significance of subjective fetal cardiac ventricular disproportion.

OBJECTIVE To evaluate fetal cardiac ventricular disproportion as a marker of cardiac anomalies. METHODS A retrospective case series included data from all patients who had a fetus diagnosed subjectively with ventricular disproportion by routine obstetric ultrasonography between January 1, 2007 and December 31, 2013 at a single tertiary center in the USA. Fetal and neonatal echocardiography, and neonatal outcome data were retrieved. Outcomes were described for all fetuses with subjective ventricular disproportion. Then, the objective right-to-left ventricular ratio (RLVR) was calculated as a continuous (after transformation to gestational age specific z-scores) or categorical value (>2SD for gestational week), based on previously published reference values. Subsequently, correlations between the objective RLVR and neonatal outcomes were evaluated. RESULTS Records from 60 fetuses diagnosed with ventricular disproportion at 16-38 weeks of gestation were included. These pregnancies resulted in 54 live deliveries; postnatally, 20 (37%) of these neonates were diagnosed with aortic coarctation and 39 (72%) were diagnosed with other cardiac anomalies, with or without aortic coarctation. No significant differences in objective prenatal diagnostic findings (RLVR) were demonstrated between neonates who were diagnosed postnatally with aortic coarctation or any cardiac anomaly and those not. CONCLUSION Subjective ventricular disproportion, regardless of objective diagnosis, was associated with cardiac defects. The use of fetal and neonatal echocardiography following diagnosis of fetal ventricular disproportion appears justified.