A Fetal Risk Stratification Pathway for Neonatal Aortic Coarctation Reduces Medical Exposure

Incremental Value of Myocardial Deformation in Predicting Postnatal Coarctation of the Aorta: Establishment of a Novel Diagnostic Model

“…For these fetuses, delivery at a tertiary center with a neonatal intensive care unit and prostaglandin administration immediately after birth are inevitable, and timely surgical repair is necessary. 35 Those fetuses with probabilities between 20% and 60% have a moderate risk for CoA and should be monitored with serial prenatal echocardiography to record the growth of left-sided cardiac structures or progression of the initial abnormalities. 36 In addition, newborns with inconclusive CoA require close surveillance, mainly by serial echocardiography to confirm or exclude CoA.…”

Diagnostic accuracy of prenatal ultrasound in coarctation of aorta: systematic review and individual participant data meta‐analysis

“…Of note, other proposed parameters targeting vascular function, such as Doppler analysis of aortic arch flow and the presence of a posterior or juxtaductal shelf, did not prove to be effective after adjusting for GA at evaluation and the presence of a persistent left superior vena cava. Evaluation of the aortic arch flow using Doppler 30 and other imaging modalities, such as computational fluid dynamics 31 and fetal cardiac magnetic resonance imaging (MRI) 32 , has been shown to improve the fetal diagnosis of CoA by allowing evaluation of hemodynamics as well as aortic arch anatomy. The low diagnostic power of Doppler parameters in our study could be explained by considering the following three points: first, most studies used ultrasound evaluation at the first suspicion, in which function may not yet be affected; second, milder forms of prenatal CoA may not be associated with vascular dysfunction at any point in pregnancy; and, third, we could evaluate only some of these parameters in a relatively small number of cases.…”

“…Table S4 Main characteristics of included studies 15,22,30,[37][38][39][40][41][42][50][51][52][53][54][55][56][57] Table S5 Results of meta-analysis evaluating association between selected single categorical ultrasound parameters and gestational age with presence of coarctation of aorta Table S6 Results of meta-analysis evaluating association between combinations of selected categorical ultrasound parameters and gestational age with presence of coarctation of aorta Table S7 Main characteristics of eligible studies that were not included in systematic review and meta-analysis 31,[43][44][45][46][47][48]58 Ultrasound Obstet Gynecol 2024; 63: 446-456 Published online 9 March 2024 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.27576.…”

“…Multivariate models have been proposed in an attempt to improve diagnostic accuracy over single parameters, with excellent diagnostic rates and most sensitivity and specificity values exceeding 80% reported in the literature 22,30,31,[37][38][39][40][41][42][43][44][45][46][47][48] . In our study, models combining different parameters were not as successful.…”

Learning the Hidden Signature of Fetal Arch Anatomy: a Three-Dimensional Shape Analysis in Suspected Coarctation of the Aorta

“…Coarctation of the aorta (CoA) is one of the most common congenital heart defects, affecting 7–8% of all live births with congenital heart disease [ 1 ] and is characterized by a discrete narrowing in the region of the aortic isthmus after postnatal closure of the arterial duct (AD) with a variable degree of hypoplasia of the aortic arch. Prenatal diagnosis of neonatal or duct-dependent CoA is associated with reduced morbidity and mortality [ 2 ] but remains challenging, with false positive rates of diagnosis ranging from 20–30% up to 80% [ 3 – 5 ], posing unnecessary stress on parents and a burden on healthcare systems because, after birth, these babies need to be observed in a hospital setting to check for clinical and echocardiographic signs of aortic arch obstruction [ 6 – 8 ].…”