{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:53:59Z","timestamp":1785401639159,"version":"3.56.0"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100005860","name":"Helsefonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005860","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Fetuses with hypoplastic left heart syndrome (HLHS) and restrictive\/intact atrial septum (RAS) have high mortality, partly due to pulmonary lymphangiectasia (PL). This study aimed to characterize atrial septal morphology in fetuses with HLHS and RAS and evaluate the impact of fetal intervention on PL and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We retrospectively reviewed clinical data, fetal echocardiograms, and MRIs from all fetuses with HLHS\/HLHS\u2010variants and RAS over 20\u00a0years. RAS was defined as pulmonary venous forward\u2010to\u2010reverse VTI ratio \u2264 5:1.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 54 fetuses (gestational age of 24.2\u00a0weeks; 21.2\u201328.1) with HLHS (81%) or HLHS variant (19%) and RAS. Most had a hypoplastic left atrium (LA, 80%). Four atrial septal morphology patterns were identified. PL was present among all patterns and associated with lower VTI ratio (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.046). Mean VTI ratio improved in fetuses who underwent atrial septal intervention (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a012), compared to those without (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001). Among five fetuses with pre\u2010intervention PL and serial MRIs, three improved. Seventeen neonates were live\u2010born with intention\u2010to\u2010treat; 6\u2010months mortality was 38% with no difference by morphology pattern, PL, or fetal intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Most fetuses with HLHS and RAS had hypoplastic LA. VTI ratio correlated with PL on fetal lung MRI, and most improved with fetal atrial septal intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pd.70000","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T05:13:57Z","timestamp":1762233237000},"page":"183-192","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Fetal Diagnosis of Hypoplastic Left Heart Syndrome With Restrictive Atrial Septum\u2014Atrial Septal Morphology, Associated Lung Disease and Outcomes"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9997-1514","authenticated-orcid":false,"given":"Sofie","family":"Dannesbo","sequence":"first","affiliation":[{"name":"Labatt Family Heart Centre The Hospital for Sick Children University of Toronto  Toronto Ontario Canada"},{"name":"Department of Cardiology The Heart Centre Copenhagen University Hospital Rigshospitalet  Copenhagen Denmark"},{"name":"Faculty of Health and Medical Sciences University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Ho","sequence":"additional","affiliation":[{"name":"Ted Rogers Computational Program Peter Munk Cardiac Centre University Health Network University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Seed","sequence":"additional","affiliation":[{"name":"Labatt Family Heart Centre The Hospital for Sick Children University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vitor","family":"Guerra","sequence":"additional","affiliation":[{"name":"Labatt Family Heart Centre The Hospital for Sick Children University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Chaturvedi","sequence":"additional","affiliation":[{"name":"Labatt Family Heart Centre The Hospital for Sick Children University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew C.","family":"Cook","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Sciences University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Vejlstrup","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Heart Centre Copenhagen University Hospital Rigshospitalet  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasper","family":"Iversen","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Cardiology Copenhagen University Hospital Herlev  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Bundgaard","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Heart Centre Copenhagen University Hospital Rigshospitalet  Copenhagen Denmark"},{"name":"Faculty of Health and Medical Sciences University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay R.","family":"Freud","sequence":"additional","affiliation":[{"name":"Labatt Family Heart Centre The Hospital for Sick Children University of Toronto  Toronto Ontario 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