Comparisons of foramen ovale flap in the fetuses with true and false positive diagnosis of coarctation of the aorta

Ruan, Peng; Zheng, Qiao; He, Miao; Shang, Jin; Xie, Hong‐Ning

doi:10.21037/qims-21-644

Cited by 6 publications

(3 citation statements)

References 17 publications

(21 reference statements)

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“…On the other hand, we have observed that the presence of a redundant foramen ovale was associated with a lower risk of CoA. This parameter is often found in fetuses with cardiac asymmetry and right dominance (mainly after 28 weeks) in which CoA is not confirmed after birth, probably owing to a restriction to the blood flow into the left ventricle because a large part of the left atrial cavity is occupied by the foramen ovale flap 33,34 .…”

Section: Discussionmentioning

confidence: 93%

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

Villalaín,

D'Antonio,

Flacco

et al. 2024

Ultrasound in Obstet & Gyne

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Objectiveto determine the diagnostic accuracy of prenatal ultrasound (US) in detecting coarctation of aorta (CoA).Methodsan individual participant data meta‐analysis was performed to report the strength of association and diagnostic accuracy of different US signs in detecting CoA prenatally. MEDLINE, Embase, and CINAHL were searched from January 2000 until November 2021. Individual participant‐level data was obtained by two leading teams. PRISMA‐IPD and PRISMA‐DTA guidelines were used for abstracting data and the QUADAS‐2 tool for assessing quality and applicability. The reference standard was CoA diagnosed after birth defined as narrowing of the aortic arch. The index test included the most commonly evaluated parameters on US both in B‐Mode and Doppler. Summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and likelihood ratios were computed using hierarchical summary receiver–operating characteristics.ResultsThe initial search yielded 72 studies of which 25 met the inclusion criteria (evaluation of fetuses with suspected CoA considered as isolated cardiac and/or great vessels disproportion with right dominance on US assessment). Seventeen studies (640 fetuses) were included. At random effect logistic regression analysis, tricuspid/mitral valve ratio > 1.4 and >1.6, aortic isthmus/arterial duct ratio <0.7, hypoplastic arch (all p<0.001), aortic isthmus z‐score <2 at sagittal (p=0.003) and 3‐vessel view (p<0.001), pulmonary artery/ascending aorta ratio (p=0.048), bidirectional flow at the foramen ovale (p=0.012) and redundant foramen ovale (p=0.037) were independently associated with CoA. Regarding diagnostic accuracy, tricuspid/mitral valve ratio >1.4 had a sensitivity of 72.6% (95%CI, 48.2‐88.3), a specificity of 65.4% (95%CI, 46.9‐80.2), and a DOR of 5.02 (95%CI, 1.82‐13.9). The respective sensitivity/specificity figures for pulmonary artery/ascending aorta ratio >1.4, aortic isthmus z‐score <‐2 at sagittal and aortic isthmus at 3‐vessel views were 75.0% (95%CI, 61.1‐86.0)/39.7% (95%CI, 27.0‐53.4), 47.8% (95%CI, 14.6‐83.0)/87.6% (95%CI, 27.3‐99.3) and 74.1% (95%CI, 58.0‐85.6)/62.0% (95%CI, 41.6‐78.9). Hypoplastic arch had a sensitivity of 70.0% (95%CI, 42.0‐88.6), a specificity of 91.3 (95%CI, 78.6‐96.8), and a DOR of 24.9 (95%CI, 6.18‐100). Continuous parameters were independently associated with CoA (all, p<0.001) but all had low‐moderate diagnostic yield, same as multivariate models.ConclusionsSeveral prenatal ultrasound parameters are associated with an increased risk for postnatal CoA. However, diagnostic accuracy is only moderate, even when combined.This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 93%

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

Villalaín,

D'Antonio,

Flacco

et al. 2024

Ultrasound in Obstet & Gyne

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“…7-N° 3, 2023, pp. 1291-1312 Journal Scientific MQRInvestigar 1305 de anillo mitral fue <7.3mm, anillo aórtico <5.4mm e istmo aórtico <3mm, por lo cual se concluye que, la evaluación de estos puntos sobre todo durante el trimestre tres de embarazo ayudan a predecir la CoAo, por lo que, se requerirá de análisis clínicos después del pato para confirmar estos resultados; y finalmente un caso similar en donde se estudió cincuenta y siete fetos con sospecha de CoAo fueron sometidos por ECO por Peng R, et al, (49), de los cuales solo el 19,2% tuvieron la patología confirmada posterior a su nacimiento. Con los resultados expuesto por los autores podemos deducir, que los métodos de diagnóstico para predicción y medición de los parámetros cardiacos para detectar la patología deben ser completados unos con otros e investigar clínicamente más a fondo estos procedimientos para lograr una disminución significativa de falsos positivos de CoAo en RN.…”

Section: Discussionunclassified

Coartación de la aorta: diagnóstico pediátrico y reparación.

López-Maldonado,

Ochoa-Bravo

2023

MQRInvestigar

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Antecedentes: La Coartación de la aorta es una patología congénita que se describe como el estrechamiento de la aorta, ocasionando obstáculo del paso de la sangre; a esta enfermedad se atribuye del 8 al 10% de cardiopatías genéticas, lo que equivale a 4/10000 nacidos vivos y suele ser detectada en edad adulta. Objetivo: Establecer el diagnóstico, tratamiento y controversia acerca de la Coartación de la Aorta en pacientes pediátricos. Métodos: Revisión bibliográfica de tipo narrativa. Resultados: Los métodos con la tasa más alta de eficacia en diagnóstico para fetos y recién nacidos son el ecocardiograma y la medición arterial bajo los parámetros cardíacos, más del 50% de casos reportados fueron confirmados posterior al nacimiento; los métodos de tratamiento usados son la angioplastia con balón y colocación de stent permitiendo la mejoría de los pacientes, tomando en cuenta la incidencia del 10 y 20% de reintervención en los pacientes tratados. Aunque existe cierta controversia, autores recomiendan la angioplastia con balón en recién nacidos; mientras que otros grupos demuestran que una corrección quirúrgica para el tratamiento es efectiva. Conclusiones: La Coartación de la aorta es un defecto, que generalmente es diagnosticada después del nacimiento, entre los exámenes complementarios pueden ser el ecocardiograma, tomografía axial computarizada y resonancia magnética. El tratamiento de mayor utilidad puede ser la angioplastia con balón o inserción de stent, es importante que los pacientes reparados tengan un seguimiento a largo plazo por los posibles riesgos.

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“…Vena et al [2] found that in fetuses with RFOF without restrictive foramen ovale (RFO), there may be manifestations on fetal echocardiography mimicking aortic stenosis(AS) or coarctation of the aorta (CoA), especially in type III RFOF. Peng et al [3] 's study similarly indicated that the presence of RFOF can increase the false-positive rate of CoA. Additionally, previous case reports [4][5] have also documented that the redundant flap leads to reduced flow through the mitral valve, consequently causing ventricular disproportion, characterized by a diminishment in the size of the left ventricle.…”

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confidence: 92%

Type Ⅲ fetal redundancy of the foramen ovale flap mimics hemodynamic changes of mitral stenosis: report of 2 cases and literature review

Peng,

Zhang,

Pan

et al. 2024

Preprint

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Previous studies have shown that Type Ⅲ redundancy of the foramen ovale flap (RFOF) can mimic the hemodynamic features of other congenital heart diseases (CHD), potentially causing misdiagnosis during the fetal period. In this study, we present two cases of Type Ⅲ RFOF in fetuses, which can mimic mitral stenosis (MS). This manifestation has not been particularly highlighted in previous literature. However, this type of MS carries a favorable prognosis.

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Comparisons of foramen ovale flap in the fetuses with true and false positive diagnosis of coarctation of the aorta

Abstract: Contributions: (I) Conception and design: HN Xie; (II) Administrative support: JH Shang; (III) Provision of study materials or patients: Q Zheng;

Cited by 6 publications

References 17 publications

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

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

Coartación de la aorta: diagnóstico pediátrico y reparación.

Type Ⅲ fetal redundancy of the foramen ovale flap mimics hemodynamic changes of mitral stenosis: report of 2 cases and literature review

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