Common arterial trunk in the era of high prenatal detection rates: Results of neonatal palliation and primary repair

Evans, W.N.; Acherman, Ruben J.; Ciccolo, Michael L.; Lehoux, Juan; Galindo, Alvaro; Rothman, Abraham; Mayman, G. A.; Restrepo, Humberto

doi:10.1111/jocs.15964

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…The current standard of care is neonatal repair of the defect, with reconstruction of the right ventricular outflow tract by various techniques [3][4][5] . Although there has been a decrease in surgical mortality and morbidity over time [6][7][8] , interrupted aortic arch, truncal valve dysfunction with insufficiency or stenosis, coronary abnormalities and DiGeorge syndrome remain risk factors for adverse outcome 3,7,9 .…”

Section: Introductionmentioning

confidence: 99%

Accuracy and impact of prenatal diagnosis of common arterial trunk

Laux

Derridj

Stirnemann

et al. 2022

Ultrasound in Obstet & Gyne

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Objectives Outcome of common arterial trunk (CAT) depends mainly on truncal valve function, presence of coronary artery abnormalities and presence of interrupted aortic arch. The main objective of this study was to evaluate the accuracy of prenatal diagnosis of CAT by analyzing prenatal vs postnatal assessment of: (1) anatomic subtypes and (2) truncal valve function. The secondary objective was to assess the potential impact of prenatal diagnosis of CAT on postnatal mortality and morbidity by comparing prenatally vs postnatally diagnosed patients. Methods This was a retrospective analysis of all CAT patients diagnosed either prenatally, with postnatal or fetopsy confirmation, or postnatally, from 2011 to 2019 in a single tertiary center. Cohen's kappa statistic was used to evaluate agreement between pre‐ and postnatal assessment of anatomic subtypes according to Van Praagh and of truncal valve function. Mortality and morbidity variables were compared between prenatally vs postnatally diagnosed CAT patients. Results A total of 84 patients (62 liveborn with prenatal diagnosis, 16 liveborn with postnatal diagnosis and six terminations of pregnancy with fetopsy) met the inclusion criteria. The accuracy of prenatal diagnosis of CAT anatomic subtype was 80.3%, and prenatal and postnatal concordance for subtype diagnosis was only moderate (κ = 0.43), with no patient with CAT Type A3 (0/4) and only half of patients with CAT Type A4 (8/17) being diagnosed prenatally. Fetal evaluation of truncal valve function underestimated the presence (no agreement; κ = 0.09) and severity (slight agreement; κ = 0.19) of insufficiency. However, four of five cases of postnatally confirmed significant truncal valve stenosis were diagnosed prenatally, with fair agreement for both presence and severity of stenosis (κ = 0.38 and 0.24, respectively). Mortality was comparable in patients with and those without prenatal diagnosis (log‐rank P = 0.87). CAT patients with fetal diagnosis underwent earlier intervention (P < 0.001), had shorter intubation time (P = 0.047) and shorter global hospital stay (P = 0.01). Conclusions The accuracy of prenatal diagnosis of CAT is insufficient to tailor neonatal management and to predict outcome. Fetal assessment of truncal valve dysfunction appears unreliable due to perinatal transition. Improvement is necessary in the fetal diagnosis of anatomic subtypes of CAT requiring postnatal prostaglandin infusion. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Introductionmentioning

confidence: 99%

Accuracy and impact of prenatal diagnosis of common arterial trunk

Laux

Derridj

Stirnemann

et al. 2022

Ultrasound in Obstet & Gyne

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show abstract

“…Due to the challenging nature of accurate CAT assessment before delivery, many cases may be misdiagnosed during prenatal ultrasonography screening. 5 The prevalence of complex intra-and extra-cardiac malformations was 51.8% and 27.8%, respectively, in a large proportion of fetuses in this study, and only 20.4% of the fetuses were isolated CAT. In comparison, the incidence of CAT complicated with intra-cardiac malformations was higher (54.55%), and the incidence of extra-cardiac malformations was consistent with that reported by Gomez et al 6 However, Abel et al reported a high incidence of extra-cardiac malformations of 58.8%.…”

Section: Discussionmentioning

confidence: 48%

“…Due to the challenging nature of accurate CAT assessment before delivery, many cases may be misdiagnosed during prenatal ultrasonography screening 5 . The prevalence of complex intra‐ and extra‐cardiac malformations was 51.8% and 27.8%, respectively, in a large proportion of fetuses in this study, and only 20.4% of the fetuses were isolated CAT.…”

Section: Discussionmentioning

confidence: 67%

Clinical value of prenatal ultrasound in diagnosis and classification of common arterial trunk

et al. 2023

J of Clinical Ultrasound

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ObjectivesTo investigate the clinical value of prenatal ultrasound in the diagnosis of the common arterial trunk (CAT) classification and associated malformations.Materials and MethodsThe 2D ultrasound images, spatiotemporal image correlations (STICs) and clinical data of 88 fetuses diagnosed with CAT malformations by prenatal ultrasound were retrospectively analyzed and classified. The correlation between different types, fetal malformation and pregnancy outcomes were analyzed.ResultsAmong the 88 fetuses, there were 39 cases (44.32%) of type A1, 40 cases (45.45%) of type A2, 8 cases (9.09%) of type A3, and 1 case of type A4 (1.14%). There were 16 cases (18.18%) with isolated CAT, 48 cases (54.55%) with complex intra‐cardiac structural abnormalities, and 24 cases (27.27%) with intra‐cardiac and extra‐cardiac structural abnormalities. In extra‐cardiac structural malformations, 14 cases were associated with 1 other system abnormality, 4 cases with 2 other system abnormalities, 3 cases with 3 other system abnormalities, while 3 cases were combined with 4 other system abnormalities, among which the facial and physical abnormalities had the highest incidence (39.13%). The STIC images were completely displayed in all 88 cases. There was a statistical difference between isolated CAT and CAT combined with other abnormalities in fetal pregnancy outcomes.ConclusionsPrenatal ultrasound had a high clinical application value in CAT classification. Pregnancy outcomes were highly correlated with the classification and associated intra‐cardiac and extra‐cardiac structural malformations. The early evaluation of fetal prognosis before birth has important value for clinical intervention.

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“…As an accurate prenatal assessment of CAT is extremely challenging, many cases may be misdiagnosed during prenatal ultrasonography screening. 5 A large proportion of foetuses in this study had complex intra-cardiac and extra-cardiac malformations, with prevalence rates of 51.8% and 27.8%, respectively, and only 20.4% of the foetuses were isolated. In contrast, the incidence of CAT complicated with intra-cardiac malformations was higher (51.8%), and the incidence of extra-cardiac malformations was consistent with that reported by Gomez et al 6 However, Abel et al reported that the incidence of extra-cardiac malformations was 58.8%.…”

Section: Discussionmentioning

confidence: 66%

Clinical value of ultrasound in diagnosis and classification of common arterial trunk

et al. 2022

Preprint

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Objectives: This study aims to explore the clinical value of prenatal ultrasonography in the diagnosis of the common arterial trunk (CAT) classification and associated deformities. Materials and methods: The two-dimensional ultrasound images spatiotemporal image correlations (STICs) and clinical data of 108 foetuses diagnosed with CAT malformations were retrospectively analysed, their CAT types were classified, and the correlations between these different types and foetal malformations and pregnancy outcomes were analysed. Results: Among the 108 foetuses, there were 47 cases (43.5%) of type A1, 51 cases (47.3%) of type A2, 9 cases (8.3%) of type A3 and 1 case of type A4 (0.9%), of which 22 cases (20.4%) were isolated CAT, 56 cases (51.8%) had complex intra-cardiac structural abnormalities, 30 cases (27.8%) had intra-cardiac or extra-cardiac structural abnormalities, 17 cases had 1 other system abnormality, and 5 cases had 2 other system abnormalities. Four cases were combined with 3 other system abnormalities, while 4 cases were combined with 4 other system abnormalities, among which the facial and physical abnormalities had the highest incidence (40.0%). The STIC images were completely displayed in 88 cases (81.5%). Isolated CAT and CAT combined with other malformations were significantly correlated with foetal pregnancy outcomes ( P < 0.05). Conclusions: Prenatal ultrasonography had a high clinical application value for classifying CAT. Pregnancy outcomes were highly correlated with the classification and combined intra-cardiac and extra-cardiac structural malformations. The early assessment of foetal prognosis before birth has great value for clinical intervention.

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Common arterial trunk in the era of high prenatal detection rates: Results of neonatal palliation and primary repair

Cited by 5 publications

References 19 publications

Accuracy and impact of prenatal diagnosis of common arterial trunk

Accuracy and impact of prenatal diagnosis of common arterial trunk

Clinical value of prenatal ultrasound in diagnosis and classification of common arterial trunk

Clinical value of ultrasound in diagnosis and classification of common arterial trunk

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