Echocardiographic Parameters for Predicting Biventricular Circulation in Fetuses with PAIVS

All articles of this category (opens in new window) Background: Prenatal echocardiographic markers for biventricular (BV) or nonbiventricular (non-BV) postnatal circulation in fetuses with pulmonary atresia and intact ventricular septum (PAIVS) are still actively discussed in the literature. This study assessed the influence of 2D-speckle-tracking echocardiography (2D-STE) parameters, cardiac Z-scores, and fetomaternal Doppler indices on postnatal outcomes in fetuses with PAIVS. Methods: It was a retrospective single-center study of 30 fetuses with PAIVS born between January 2008 and January 2025. Two-dimensional-STE parameters were analyzed from four-chamber views, with atrial and ventricular strain assessment. Z-scores were calculated for all cardiac valves (MVA, TVA, AoV, PVA) and ventricular lengths (LVL, RVL). And fetomaternal Doppler sonography included ductus venosus indices and cerebroplacental ratio (CPR). Results: A BV outcome was confirmed in 11 cases (36.7%), while 12 (40.0%) patients had a non-BV outcome, including 8 univentricular and four 1.5-venricular circulations. Seven (23.3%) cases were unclassified due to loss of follow-up or perinatal death. No significant differences were found in global longitudinal strain (EndoGLS) between the BV and non-BV groups. In the second trimester, non-BV fetuses showed smaller RV areas and lengths, reduced LV septal MAPSE, and reduced RA volumes ( p < 0.05; d = 0.60–0.75). In the third trimester, LV end-systolic area and volume were increased ( p < 0.05; d = 0.48–0.82). Additional differences included decreased aortic Vmax in the second trimester ( p < 0.05; d = 0.81), and lower PVA/AoVA ratio and pulmonary valve Z-score in the third ( p < 0.05; d = 0.56–0.60). The most significant Doppler difference was found in reduced CPR ( p < 0.05; d = 0.45) in both trimesters, indicating chronic cardiac output reduction and fetal compensation (brain-sparing effect) in fetuses from the non-BV group. Conclusion: Significant prenatal predictors for non-BV outcome were identified using 2D-STE areas and volumes, cardiac Z-scores, and CPR. Combining different parameters may improve the prediction of postnatal circulation in fetuses with PAIVS. However, larger multicenter studies with a broader evaluation of STE parameters are needed. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany