A clinical prediction model to estimate the risk for coarctation of the aorta: From fetal to newborn life

Wang, Xi-Ming; Zhu, Mei; Liang, Hao; Feng, Jiaxuan; Zhang, Nan; Wang, Yue-Mei; Wang, An-Biao

doi:10.1111/jog.15341

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…This study is the first to propose the measurement of AAO-DAO angle and TAO-DAO angle in CoA children in CTA images. No significant difference was seen in the TAO-DAO angle among the three groups, and the results were similar to Wang's study ( 20 ). AAO-DAO angle exists differently when the arch morphology is different, and compared with the crenel arch and the romanesque arch, the AAO-DAO of the gothic arch is small and sharp.…”

Section: Discussionsupporting

confidence: 88%

Using computed tomography angiography and computational fluid dynamics to study aortic coarctation in different arch morphologies

et al. 2023

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ObjectiveTo study the differences in computed tomography angiography (CTA) imaging of gothic arches, crenel arches, and romanesque arches in children with Aortic Coarctation (CoA), and to apply computational fluid dynamics (CFD) to study hemodynamic changes in CoA children with gothic arch aorta.MethodsThe case data and CTA data of children diagnosed with CoA (95 cases) in our hospital were retrospectively collected, and the morphology of the aortic arch in the children was defined as gothic arch (n = 27), crenel arch (n = 25) and romanesque arch (n = 43). The three groups were compared with D1/AOA, D2/AOA, D3/AOA, D4/AOA, D5/AOA, and AAO-DAO angle, TAO-DAO angle, and aortic arch height to width ratio (A/T). Computational fluid dynamics was applied to assess hemodynamic changes in children with gothic arches.ResultsThere were no significant differences between D1/AOA and D2/AOA among gothic arch, crenel arch, and romanesque arch (P > 0.05). The differences in D3/AOA, D4/AOA, and D5/AOA among the three groups were statistically significant (P < 0.05), D4/AOA, D5/AOA of the gothic arch group were smaller than the crenel arch group, and the D3/AOA and D5/AOA of the gothic arch group were smaller than the romanesque arch group (P < 0.05). The difference in AAO-DAO angle among the three groups was statistically significant (P < 0.05), and the AAO-DAO angle of gothic arch was smaller than that of romanesque arch and crenel arch group (P < 0.05). There was no significant difference in the TAO-DAO angle between the three groups (P > 0.05). The difference in A/T values among the three groups was statistically significant (P < 0.05), and the A/T values: gothic arch > romanesque arch > crenel arch (P < 0.05). The CFD calculation of children with gothic arch showed that the pressure drop between the distal stenosis and the descending aorta was 58 mmHg, and the flow rate at the isthmus and descending aorta was high and turbulent.ConclusionGothic aortic arch is common in CoA, it may put adverse effects on the development of the aortic isthmus and descending aorta, and its A/T value and AAO-DAO angle are high. CFD could assess hemodynamic changes in CoA.

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Section: Discussionsupporting

confidence: 88%

Using computed tomography angiography and computational fluid dynamics to study aortic coarctation in different arch morphologies

et al. 2023

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“…In the study by Wang et al, logistic regression analysis was conducted to develop a probability model for the prenatal diagnosis of CoA [ 20 ]. The model incorporated prenatal cardiac sonographic markers and achieved an optimal criterion of >0.25, resulting in a sensitivity of 97.7% and specificity of 59.1%.…”

Section: Discussionmentioning

confidence: 99%

The Predictive Value of the CSA Index in the Prenatal Diagnosis of Aortic Coarctation in Ultrasound Examination Performed during the Second Trimester

Zych-Krekora

Krekora

Grzesiak

et al. 2023

JCM

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Background: Aortic coarctation (CoA) is the fourth most common congenital heart defect (8–10%) which occurs at a frequency of about 20–60/100,000 births. Only 22.3% of all cases appears to be diagnosed during the second trimester of pregnancy. Since the detection of prenatal aortic coarctations is very low, every effort should be made to change this situation. According to the authors of this study, the CSAi (carotid to subclavian artery index) could serve as a reliable indicator. Material and Methods: Ninety-six fetuses from healthy, single, pregnancies, with good ultrasound visualization between 18 and 27.5 weeks of gestation, and twenty-three fetuses suspected of aortic coarctation (postnatally confirmed) were included in this study. Our first aim was to compare the current most common method of prenatal CoA diagnosis based on the measurement of the aortic z-score in the aortic isthmus using the method suggested by us-CSAi. Results: Logistic regression coefficients for z-score and CSAi were analyzed as predictors of coarctation occurrence. It appears that 39.4% of coarctation occurrence can be predicted on the basis of the z-score, and 93.5% on the basis of the CSAi. The cut-off value for CSAi in the study group was 0.81 (sensitivity: 95.7%, specificity 99%). Based on the ROC curve analysis, the cut-off value for the carotid to subclavian distance (mm) was determined; the risk of coarctation increased above this value. Based on the Gini index (0.867), this value was set at 2.55 (sensitivity 82.6%, specificity 93.7%). Conclusions: CSAi measurement is currently the most sensitive method for aortic coarctation detection. For the purpose of our study, this method was applied in diagnostics in the second trimester of pregnancy. This method is easy, reproducible and should be widely introduced into everyday echocardiographic diagnostics of coarctation to minimize the risk of error.

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“…Another important consideration in aortic surgery is the choice of anesthesia technique. General anesthesia is typically used for aortic surgery, but there is ongoing debate about the relative merits of different approaches such as total intravenous anesthesia (TIVA) versus inhalational anesthesia [46,47]. TIVA has been shown to reduce the risk of postoperative delirium and cognitive dysfunction, but may be associated with longer recovery times and higher costs .…”

Section: Anesthetic Implications Of Aortic Surgerymentioning

confidence: 99%

Optimising anesthesia support during operations on the abdominal aorta and its branches

2022

FEM

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Background: Pathology of the aorta includes aortic aneurysms, coarctation, dissection, atherosclerotic disease, and aortitis. The only two evidence-based treatment options for abdominal aortic repair are endovascular and open surgery. The anesthetic approach and medications may impact the outcomes of the surgical repair of the abdominal aorta and its branches. Aim: to evaluate the use of various analgesic regimens and local, regional, or general anesthesia in "optimising" surgical outcomes in patients undergoing surgical repair of the abdominal aorta and its branches. Methods: In this review, English studies from common databases such as Pubmed/MEDLINE, Google Scholar, Web of Science, Scopus, and the Cochrane Library with the keywords "Abdominal aorta," "operations," "aortic branches," combined with keywords, involving " anesthesia were involved." The end date for this review was November 2022. Scientific novelty: Recent scientific studies have focused on the use of advanced monitoring technologies such as cerebral oximetry and microdialysis to improve the safety and efficacy of anesthesia management in aortic surgery. These technologies provide more accurate and real-time information about cerebral perfusion and metabolism, allowing the anesthesiologist to identify and manage potential complications such as cerebral ischemia more effectively. Additionally, the use of pharmacological agents such as dexmedetomidine and remifentanil has been shown to reduce the risk of postoperative delirium and cognitive dysfunction, further improving patient outcomes. Conclusion: Aortic surgery is a complex and high-risk procedure that requires careful management of anesthesia to ensure patient safety and optimal outcomes. With ongoing advances in anesthesia techniques and monitoring technologies, there is reason to be optimistic about the future of aortic surgery and the prospects for improved patient outcomes. The anesthesiologist plays a critical role in this process, working closely with the surgical team to provide safe and effective anesthesia throughout the procedure and ensuring that the patient receives appropriate pain management and other supportive care in the postoperative period

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A clinical prediction model to estimate the risk for coarctation of the aorta: From fetal to newborn life

Cited by 4 publications

References 29 publications

Using computed tomography angiography and computational fluid dynamics to study aortic coarctation in different arch morphologies

Using computed tomography angiography and computational fluid dynamics to study aortic coarctation in different arch morphologies

The Predictive Value of the CSA Index in the Prenatal Diagnosis of Aortic Coarctation in Ultrasound Examination Performed during the Second Trimester

Optimising anesthesia support during operations on the abdominal aorta and its branches

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