Factors affecting the prognosis of Ebstein's anomaly during fetal life

Background The echocardiographic criteria that have been used to evaluate severity of Ebstein's anomaly in utero are the same as those applied after birth. Objective The objective of this study was to establish prognostic criteria that take into account the peculiarities of the fetal hemodynamics. Method The video recordings of eight fetuses with Ebstein's anomaly were retrospectively reviewed. Results The following indexes had no prognostic significance either on fetal or neonatal outcome: the ratio of functional tricuspid opening over the diameter of the annulus, the degree of displacement of the tricuspid valve opening, and the degree of tricuspid regurgitation. The index of severity (based on the surfaces of right atrium + atrialized right ventricle) and the cardiothoracic ratio had a significant impact only on neonatal survival. The smallest fossa ovalis were found in two fetuses who had hydrops. Fetuses who reached term without problems had higher left ventricular outputs. A positive linear correlation was found between the z score of the left ventricular output and the size of the fossa ovalis ( r = 0.81, p < 0.05). Conclusion The prognosis of Ebstein's anomaly during fetal life is not influenced by criteria described for postnatal life and may be related to factors that control the volume load of the left ventricle. (Am Heart J 1998;135:1081-5.)