Prenatal prediction of Shone's complex. The role of the degree of ventricular disproportion and speckle-tracking analysis

Objectives: Shone's complex (SC) is characterized by sequential obstructions of left ventricular (LV) inflow and outflow. It can be associated with poor long-term prognosis when compared to Simple-Aortic Coarctation (S-CoA). We aimed to assess whether the degree of ventricular disproportion and 2D-speckle-tracking echocardiography (2D-STE) could improve the accuracy of prenatal prediction of SC. Methods: 75 consecutive fetuses were retrospectively enrolled from January 2010 to June 2021. Fetuses were divided into 4 groups (Group 1: SC; Group 2: S-CoA; Group 3: False Positive-Coarctation of the Aorta [FP-CoA]; group 4: controls). Comparisons for echocardiographic measures and myocardial deformation indices were performed. A receiver operating characteristic (ROC) analysis was performed on the MV/TV (mitral valve/tricuspid valve ratio) and LV GLS (global longitudinal strain) values to identify cut-offs to separate group 1 and 2 fetuses. Results: SC fetuses showed a significant reduction in MV/TV when compared to S-CoA and FP-CoA fetuses (p < 0.001). LV GLS in SC fetuses was significantly reduced compared to S-CoA fetuses (-13.3 & PLUSMN; 2.1% vs. -17.0 & PLUSMN; 2.2%, p=0.001). A cut-off value of 0.59 for MV/TV and -15.35% for LV GLS yielded a sensitivity of 76 and 82% and a specificity of 71 and 83% respectively in separating SC vs. S-CoA fetuses. Conclusions: SC fetuses showed a more severe degree of ventricular disproportion and a lower LV GLS compared to S-CoA, FP-CoA and control fetuses. MV/TV and GLS are both predictors of SC. These findings may improve the quality of prenatal parental counselling.

Automated summary

This study aimed to assess the impact of ventricular disproportion and two-dimensional speckle-tracking echocardiography (2D-STE) on the prenatal prediction accuracy of Shone's complex (SC). The study found that SC fetuses had a more severe degree of ventricular disproportion and lower LV GLS, and both MV/TV and LV GLS were predictors of SC. These findings are important for improving the quality of prenatal counseling.