Postnatal Angiographic Appearance of Left Ventricular Myocardium in Fetal Patients With Aortic Stenosis Having In-Utero Aortic Valvuloplasty

Fetal aortic valvuloplasty (FAV) is performed on the basis of the hypothesis that aortic stenosis leads to the impairment of left ventricular (LV) filling and growth. Given that most fetuses fail to exhibit normalization of LV growth even after successful FAV, better understanding of the associated LV myocardial pathology is indicated. Postnatal angiography was reviewed retrospectively for all patients who (1) underwent FAV for severe aortic stenosis and (2) had well-opacified LV angiograms before any surgical intervention from 2000 to 2007. The angiographic appearance of the LV myocardium was described as either smooth or trabeculated in a total of 6 anatomic segments in 2 projections (anteroposterior and lateral). Twenty-four infants who underwent FAV had angiographic images appropriate for review. Of these, 4 (17%) had uniformly smooth LV myocardium, whereas 20 (83%) had deep trabeculations of ≥1 LV myocardial segment. Half of the infants (n = 13) had extensive trabeculations with the involvement of ≥4 segments. In all cases, the septal segments were smooth. In conclusion, patients after FAV have angiographically abnormal left ventricles, commonly involving extensive trabeculations of the free wall, but without septal involvement.