{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:49:01Z","timestamp":1792590541198,"version":"4.5.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Case series report high mortality after fetal diagnosis of moderate to severe mitral regurgitation in combination with left atrial dilation, hydrops, or restrictive atrial septum. However, overall outcomes and specific high\u2010risk features remain unclear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">We performed a multicenter retrospective cohort study of fetuses with \u2265moderate mitral regurgitation and normal cardiac connections evaluated January 1, 2005 to January 31, 2016. Fetuses undergoing fetal cardiac intervention (FCI) were described separately. We assessed associations between fetal echocardiographic features and discharge mortality using mixed logistic regression and classification and regression tree modeling, stratified by studies performed &lt;28 and \u226528\u2009weeks gestational age (GA).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Of 67 fetuses, 96% had aortic valve stenosis or atresia. Among the non\u2010FCI group, fetal and discharge mortality was 10% (5\/51) and 55% (28\/51), respectively. For echocardiograms performed &lt;28\u2009weeks GA, only restrictive atrial septum (odds ratio [OR], 49.6 [95% CI, 5.6\u2013437.5]) and earlier GA at referral (OR 0.72 per increasing week GA [95% CI 0.54\u20130.96]) remained associated in multivariable analysis. For those \u226528\u2009weeks GA, in multivariable analysis, left atrial dilation (OR, 12.41 [95% CI, 2.19\u201370.33]) and lower ascending aortic\n              <jats:italic toggle=\"no\">Z<\/jats:italic>\n              score (OR per 1 unit increase, 0.61 [95% CI, 0.39\u20130.94]) remained in the model. By classification and regression tree modeling, left atrial dilation, restrictive atrial septum, and ascending aortic\n              <jats:italic toggle=\"no\">Z<\/jats:italic>\n              score &lt;\u22121.3 were the key discriminators between survivors and nonsurvivors. Most FCIs were aortic valvuloplasty (13\/16). Discharge mortality among FCI fetuses was 38%, not significantly different from non\u2010FCI once adjusting for mitral regurgitation and LA dilation.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Fetal \u2265moderate MsR is associated with high mortality. Left atrial dilation, restrictive atrial septum, and smaller ascending aorta confer highest risk for mortality.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.125.041677","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T12:04:06Z","timestamp":1752753846000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Survival to Hospital Discharge in the Fetus With Moderate to Severe Mitral Regurgitation Either in Isolation or in Combination With Aortic Valve Stenosis or\u00a0Atresia, a Fetal Heart Society Collaborative Study"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9600-7498","authenticated-orcid":false,"given":"Betul","family":"Yilmaz Furtun","sequence":"first","affiliation":[{"name":"Texas Children\u2019s Hospital and Baylor College of Medicine","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavitha","family":"Pundi","sequence":"additional","affiliation":[{"name":"University of California, San Francisco","place":["San Francisco, USA"]},{"name":"Phoenix Children\u2019s Hospital","place":["Phoenix, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3822-693X","authenticated-orcid":false,"given":"Anita","family":"Moon\u2010Grady","sequence":"additional","affiliation":[{"name":"University of California, San Francisco","place":["San Francisco, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0467-8962","authenticated-orcid":false,"given":"Nicole","family":"Cresalia","sequence":"additional","affiliation":[{"name":"University of California, San Francisco","place":["San Francisco, USA"]},{"name":"C.S. Mott Children\u2019s Hospital, University of Michigan","place":["Ann Arbor, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asela","family":"Nieuwsma","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Hospital and Baylor College of Medicine","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6815-6771","authenticated-orcid":false,"given":"Sarah K.","family":"Gelehrter","sequence":"additional","affiliation":[{"name":"C.S. Mott Children\u2019s Hospital, University of Michigan","place":["Ann Arbor, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8552-5396","authenticated-orcid":false,"given":"Bhawna","family":"Arya","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine, Seattle Children\u2019s Hospital","place":["Seattle, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0942-5481","authenticated-orcid":false,"given":"Mary T.","family":"Donofrio","sequence":"additional","affiliation":[{"name":"Children\u2019s National Hospital","place":["Washington, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9040-5495","authenticated-orcid":false,"given":"Christopher","family":"Statile","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Medicine and the Heart Institute, Cincinnati Children\u2019s Hospital Medical Center","place":["Cincinnati, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7363-2477","authenticated-orcid":false,"given":"Ann","family":"Kavanaugh\u2010McHugh","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center","place":["Nashville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1221-081X","authenticated-orcid":false,"given":"Lindsay","family":"Freud","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Division of Cardiology","place":["Toronto, Canada"]},{"name":"New York Presbyterian Hospital, Columbia University Irving Medical Center","place":["New York City, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elijah","family":"Bolin","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences and Arkansas Children\u2019s Research Institute","place":["Little Rock, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Warner","sequence":"additional","affiliation":[{"name":"Phoenix Children\u2019s Hospital","place":["Phoenix, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3174-1410","authenticated-orcid":false,"given":"Sowmya","family":"Balasubramanian","sequence":"additional","affiliation":[{"name":"C.S. 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