<i>Z</i>‐scores of the fetal aortic isthmus and duct: an aid to assessing arch hypoplasia

Pasquini, Luca; Mellander, Mats; Seale, Anna; Matsui, Hikoro; Roughton, Michael; Ho, S. Y.; Gardiner, Helena M.

doi:10.1002/uog.4021

Cited by 135 publications

(126 citation statements)

References 10 publications

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“…12 We assigned gestational age on the basis of completed weeks of gestation: predicted isthmal or ductal diameterϭln(predicted isthmal or ductal diameter)ϭm ln(gestational age)ϩc, and Z scoreϭ[ln(measured isthmal or ductal diameter)Ϫln(predicted isthmal or ductal diameter)]/root MSE, where m and c are the slope and intercept, respectively, of the regression equations used to predict the cardiac dimensions on the basis of the measured values of gestational age and MSE is mean squared error.…”

Section: Discussionmentioning

confidence: 99%

“…11 To enable serial objective quantification of the degree of hypoplasia present in the aortic arch, we have published Z scores for the normal diameters of the distal aortic isthmus and arterial duct measured in the 3-vessel and tracheal view. 12 The purpose of this study was first to test the applicability of our Z scores to the general population and second to see whether serial measurement would increase the specificity of the diagnosis of fetal coarctation by the specialist once a referral had been made. Third, we describe the ability of associated cardiac findings (such as ventricular septal defect, bicuspid aortic valve, and persistent left superior caval vein) and of visualization of a shelf or flow disturbance at the isthmus to increase the specificity of the diagnosis of coarctation of the aorta requiring neonatal surgery.…”

Section: Clinical Perspective P 1801mentioning

confidence: 99%

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Morphological and Physiological Predictors of Fetal Aortic Coarctation

et al. 2008

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Background-Prenatal diagnosis of aortic coarctation suffers from high false-negative rates at screening and poor specificity. Methods and Results-This retrospective study tested the applicability of published aortic arch and ductal Z scores (measured just before the descending aorta in the 3-vessel and tracheal view) and their ratio on 200 consecutive normal controls at a median of 22Ϯ0 gestational weeks (range, 15Ϯ4 to 38Ϯ4 weeks). Second, this study tested the ability of serial Z scores to distinguish fetuses with coarctation within a cohort with ventricular and/or great arterial disproportion detected at screening or fetal echocardiography. Third, it evaluated the diagnostic significance of associated cardiac lesions, coarctation shelf, and isthmal flow disturbance. We studied 44 fetuses with suspected coarctation at 24Ϯ0 weeks (range, 17Ϯ3 to 37Ϯ4 weeks). Receiver-operating characteristic curves were created. Logistic regression tested the association between z scores, additional cardiac diagnoses, and coarctation. Good separation was found of isthmal Z scores for cases requiring surgery from controls and false-positive cases, and receiver-operating characteristic curves showed an excellent area under the curve for isthmal Z score (0.963) and isthmal-to-ductal ratio (0.969). Serial isthmal Z scores improved to ϾϪ2 in suspected cases with normal outcomes; those requiring surveillance or surgery remained ϽϪ2. Minor lesions did not increase the diagnostic specificity of coarctation, but isthmal flow disturbance increased the odds ratio of true coarctation versus arch hypoplasia 16-fold. Conclusions-Isthmal

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Perspective P 1801mentioning

confidence: 99%

Morphological and Physiological Predictors of Fetal Aortic Coarctation

et al. 2008

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“…4 However, prenatal detection of coarctation has also been a problem: a new method for assessing aortic isthmus diameter has some promise to improve this. 26 We thank everyone, especially nursery and midwifery staff, who contributed to this multicentre study; Peter Skoog, of the department of biomedical engineering, for invaluable help with the pulse oximeters; and Kajsa Boll, Britt-Marie Carlsson, Anna-Maria Edwardsson, Anna Larsson, Josefin Mellander, and Niklas Smith for help with data entry. Contributors: AWG supervised and coordinated the study, set and locked the pulse oximeters, informed and educated all staff involved, handled and analysed the data, participated in the statistical analyses, and drafted and helped revise the manuscript.…”

Section: Strengths and Weaknesses Of Our Studymentioning

confidence: 99%

Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns

Granelli

Wennergren

Sandberg

et al. 2009

BMJ

Self Cite

364

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Objective To evaluate the use of pulse oximetry to screen for early detection of life threatening congenital heart disease. Design Prospective screening study with a new generation pulse oximeter before discharge from well baby nurseries in West Götaland. Cohort study comparing the detection rate of duct dependent circulation in West Götaland with that in other regions not using pulse oximetry screening. Deaths at home with undetected duct dependent circulation were included. Setting All 5 maternity units in West Götaland and the supraregional referral centre for neonatal cardiac surgery. Participants 39 821 screened babies born between 1 July 2004 and 31 March 2007. Total duct dependent circulation cohorts: West Götaland n=60, other referring regions n=100. Main outcome measures Sensitivity, specificity, positive and negative predictive values, and likelihood ratio for pulse oximetry screening and for neonatal physical examination alone. Results In West Götaland 29 babies in well baby nurseries had duct dependent circulation undetected before neonatal discharge examination. In 13 cases, pulse oximetry showed oxygen saturations ≤90%, and (in accordance with protocol) clinical staff were immediately told of the results. Of the remaining 16 cases, physical examination alone detected 10 (63%). Combining physical examination with pulse oximetry screening had a sensitivity of 24/29 (82.8% (95% CI 64.2% to 95.2%)) and detected 100% of the babies with duct dependent lung circulation. Five cases were missed (all with aortic arch obstruction). False positive rate with pulse oximetry was substantially lower than that with physical examination alone (69/39 821 (0.17%) v 729/38 413 (1.90%), P<0.0001), and 31/69 of the “false positive” cases with pulse oximetry had other pathology. Thus, referral of all cases with positive oximetry results for echocardiography resulted in only 2.3 echocardiograms with normal cardiac findings for every true positive case of duct dependent circulation. In the cohort study, the risk of leaving hospital with undiagnosed duct dependent circulation was 28/100 (28%) in other referring regions versus 5/60 (8%) in West Götaland (P=0.0025, relative risk 3.36 (95% CI 1.37 to 8.24)). In the other referring regions 11/25 (44%) of babies with transposition of the great arteries left hospital undiagnosed versus 0/18 in West Götaland (P=0.0010), and severe acidosis at diagnosis was more common (33/100 (33%) v 7/60 (12%), P=0.0025, relative risk 2.8 (1.3 to 6.0)). Excluding premature babies and Norwood surgery, babies discharged without diagnosis had higher mortality than those diagnosed in hospital (4/27 (18%) v 1/110 (0.9%), P=0.0054). No baby died from undiagnosed duct dependent circulation in West Götaland versus five babies from the other referring regions. Conclusion Introduc...

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“…The ultrasonographic diagnosis includes also Z-scores of the ascending aorta and aortic isthmus dimensions. Isthmal to ductal ratio may be helpful in exclusion of the CoA too 12,13 .…”

Section: Discussionmentioning

confidence: 99%

Original paper. Do Umbilical Cord Wrapped Around the Fetal Body Can Mimic Signs of Aortal Coarctation?

Więckowska

Zych-Krekora

Słodki

et al. 2016

Prenatal Cardiology

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Objectives: Coarctation of the aorta (CoA) is an irreversible congenital heart defect. Its prenatal diagnosis is not rare a subject to false-positive conclusion. We present a novel hypothesis explaining the basis of this error. Methods: Ten cases of prenatal suspicion of the coarctation of the aorta (based on disproportion at the level of 4 chamber view and mediastinum) coincidenced with the umbilical cord wrapped around the fetal body were found in the Filemaker datebase of the Fetal Cardiology Department. Only single pregnancies were taken into account. In all cases another cardiac and extracardiac malformations were excluded. Results: The mean maternal age was 29,6 years. The mean gestational age was 33 7/8 weeks. All fetuses were in a good cardiovascular condition. The usual position of the umbilical cord was neck, but they were also location such as nucha, abdomen or lower limb. At birth, all newborns had normal anatomy of the heart. We conclude that the explanation of the false diagnosis was haemodynamic, resulting from the compression of the fetal neck by the umbilical cord that resulted in a disproportion of cardiac blood flow, “mimicking” CoA. Conclusions: 1. Functional disturbances can mimic prenatal CoA. 2. Umbilical cord position (specially enlacing the fetus neck) should be taken into consideration in suspected cases of fetal CoA.

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Z‐scores of the fetal aortic isthmus and duct: an aid to assessing arch hypoplasia

Abstract: Objective

Cited by 135 publications

References 10 publications

Morphological and Physiological Predictors of Fetal Aortic Coarctation

Morphological and Physiological Predictors of Fetal Aortic Coarctation

Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns

Original paper. Do Umbilical Cord Wrapped Around the Fetal Body Can Mimic Signs of Aortal Coarctation?

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