Prenatal Detection of Coarctation of the Aorta in a Non-selected Population: A Prospective Analysis of 10 Years of Experience

Abstract

The objective of this study was to assess the ability of different parameters to identify fetuses requiring neonatal care for coarctation of the aorta (CoA). Between January 2003 and December 2012, 175 fetuses referred for great vessel disproportion were divided into two groups: group A (n = 51) with high risk of CoA and delivery planned in tertiary care referral center and group B (n = 124) with no increased risk of CoA. In group A, diagnosis of CoA was confirmed in 38/51 (74 %). In group B, 2/124 had CoA. Multiple logistic regression analysis identified the best combination as diffusely hypoplastic and/or angular aortic arches, ventricular septal defect and aortic valve diameter <5 mm at 36-week gestational age (GA). Positive predictive value was 75 % when vessel disproportion was noted before 28-week GA and 73 % in the third trimester. Postnatal diagnosis involved 38 cases of CoA which had not been referred. One case of CoA diagnosed after birth was referred prenatally for difficulty of screening without any defect. The results of our prospective study are in agreement with those of previous series, but our false positive rate was lower especially when the diagnosis of vascular disproportion was made at third trimester. The performance of fetal cardiac screening does not seem to be very good, but prenatal diagnosis is probably not always possible: Among our three false negative cases, two had isolated vascular disproportion and the third no risk factors.

Prenatal Sonographic Predictors of Neonatal Coarctation of the Aorta

“…Several previous studies have identified persistence of a left superior vena cava as a prenatal marker for coarctation of the aorta 23 , 38 . In contrast, we and others 2 , 5 , 17 , 37 did not find a left superior vena cava to be significantly predictive of neonatal coarctation of the aorta. Nevertheless, a dilated coronary sinus from a left superior vena cava may evoke ventricular disproportion because of relative right ventricular volume overload and may benefit from postnatal followup.…”

“…Malalignment forms of ventricular septal defects may cause coarctation by redirecting flow away from the aortic arch and toward the pulmonary artery, even during fetal life 36 . In our experience, analyzing data without including cases of a single ventricle and transposition of the great arteries, the presence of a ventricular septal defect tended toward being a significant marker ( P = .072) for predicting postnatal coarctation of the aorta, as found previously by others 37 …”

“…36 In our experience, analyzing data without including cases of a single ventricle and transposition of the great arteries, the presence of a ventricular septal defect tended toward being a significant marker (P = .072) for predicting postnatal coarctation of the aorta, as found previously by others. 37 Several previous studies have identified persistence of a left superior vena cava as a prenatal marker for coarctation of the aorta. 23,38 In contrast, we and others 2,5,17,37 did not find a left superior vena cava to be significantly predictive of neonatal coarctation of the aorta.…”

Systematic review and meta‐analysis of persistent left superior vena cava on prenatal ultrasound: associated anomalies, diagnostic accuracy and postnatal outcome

“…A total of 2708 articles were identified, of which 64 full‐text articles were assessed for their eligibility for inclusion (Appendix S2). A total of 13 studies were included in the systematic review (Figure ). These 13 studies included 501 fetuses with PLSVC; of these, 37.3% (95% CI, 33.1–41.7%; 187/501) were isolated.…”

“…CHD, congenital heart disease; echo, echocardiography; GA, gestational age at diagnosis; NS, not stated; Prosp, prospective; Retro, retrospective. 32 Esmer (2014) 31 Du (2014) 30 Jowett (2012) 29 Barrea (2011) 28 Rizzo (2008) 27 Galindo (2007) 15 Berg (2006) 14 Pasquini (2005) 13 Head (2005) 26 Chaoui (2003) 25 Machevin-Surugue (2002) 24 Rein (2000) 23 Only the first author of each study is given. A study can be awarded a maximum of one star for each numbered item within the selection and outcome categories.…”