{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T16:40:08Z","timestamp":1779381608644,"version":"3.53.1"},"reference-count":19,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,7,16]],"date-time":"2018-07-16T00:00:00Z","timestamp":1531699200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Neonates with critical left heart obstruction and intact atrial septum (IAS) or restrictive atrial septum (RAS) are at risk for hypoxia within hours of birth and remain a group at high risk for mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Prenatally diagnosed fetuses with critical left heart obstruction and IAS or RAS with follow\u2010up from January 1, 2005, to February 14, 2017, were included. Primary outcome was a composite measure of severe neonatal illness (pH\u00a0&lt;\u00a07.15, venous pH\u00a0&lt;\u00a07.10, bicarbonate\u00a0&lt;\u00a016\u00a0mmol\/L, lactic acid\u00a0&gt;\u00a05\u00a0mmol\/L, or median oxygen saturation\u00a0&lt;\u00a060% within 2\u00a0hours of birth).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 68 live born fetuses, 52 (76.5%) had hypoplastic left heart syndrome, 14 (20.5%) had critical aortic stenosis, and two (3%) had complex anatomy with mitral stenosis\/atresia. There were 27 (39.7%) fetuses with IAS and 41 (60.3%) with RAS. Severe neonatal illness was present in 36 (52.9%). The strongest discriminators for severe neonatal illness were a pulmonary vein A:R VTI\u00a0\u2264\u00a02.7 (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001, AUC 0.93) and larger pulmonary vein diameter (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.025, AUC 0.77). A:R VTI\u00a0\u2264\u00a02.7 predicted death or transplant (log\u2010rank<jats:italic>P<\/jats:italic>\u00a0=\u00a00.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In neonates with hypoplastic left heart syndrome and IAS or RAS, A:R VTI\u00a0\u2264\u00a02.7 is predictive of severe neonatal instability. This threshold can help guide resource planning, delivery management, and improve fetal intervention criteria.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pd.5322","type":"journal-article","created":{"date-parts":[[2018,6,29]],"date-time":"2018-06-29T01:48:00Z","timestamp":1530236880000},"page":"788-794","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Echocardiographic predictors of neonatal illness severity in fetuses with critical left heart obstruction with intact or restrictive atrial septum"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4070-4478","authenticated-orcid":false,"given":"Laura","family":"Gellis","sequence":"first","affiliation":[{"name":"Department of Cardiology Children's Hospital Boston Boston Massachusetts US"},{"name":"Department of Pediatrics Harvard Medical School Boston Massachusetts US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Drogosz","sequence":"additional","affiliation":[{"name":"Department of Cardiology Children's Hospital Boston Boston Massachusetts US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minmin","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Cardiology Children's Hospital Boston Boston Massachusetts US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn A.","family":"Sleeper","sequence":"additional","affiliation":[{"name":"Department of Cardiology Children's Hospital Boston Boston Massachusetts US"},{"name":"Department of Pediatrics Harvard Medical School Boston Massachusetts US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Cardiology Children's Hospital Boston Boston Massachusetts US"},{"name":"Department of Pediatrics Harvard Medical School Boston Massachusetts US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Allan","sequence":"additional","affiliation":[{"name":"Department of Cardiology Children's Hospital Boston Boston Massachusetts US"},{"name":"Department of Pediatrics Harvard Medical School Boston Massachusetts US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey C.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Cardiology, Department of Pediatrics Tufts Medical Center Boston Massachusetts US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne","family":"Tworetzky","sequence":"additional","affiliation":[{"name":"Department of Cardiology Children's Hospital Boston Boston Massachusetts US"},{"name":"Department of Pediatrics Harvard Medical School Boston Massachusetts US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3180-9764","authenticated-orcid":false,"given":"Kevin G.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Department of Cardiology Children's Hospital Boston Boston Massachusetts US"},{"name":"Department of Pediatrics Harvard Medical School Boston Massachusetts US"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,7,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000128690.35860.C5"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.04.017"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.06.061"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.3850"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(99)00225-9"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.9.262"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2010.09.043"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000135471.17922.17"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2114"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.25098"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.01.173"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.025873"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.534180"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2007.123497"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.01.033"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1325376"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.009032"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-0428"},{"key":"e_1_2_8_20_1","doi-asserted-by":"crossref","unstructured":"DavidJantzen 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