Prenatal Diagnosis of Aortic Coarctation: Prediction Algorithm according to Gestational Age

Abstract

<b><i>Objectives:</i></b> The aim of the study was first to quantify the diagnostic accuracy of predictive anatomical factors of aortic coarctation (CoA) and second to design a postnatal CoA probability algorithm according to gestational age (GA) in prenatal period. <b><i>Methods:</i></b> Global and according to GA diagnostic performance of cardiac anatomical variables using the ROC curve were evaluated in a retrospective cohort of fetuses with suspicion of CoA (2004–2020). A serial testing strategy to predict postnatal CoA by fetal echocardiography was designed. <b><i>Results:</i></b> 114 fetuses were included. Isthmus-to-ductal (I/D) ratio provided the best discrimination between healthy fetuses and those with CoA (AUC 0.91, 95% CI: 0.86–0.96, I/D < 0.74 sensitivity 96.3%, I/D < 0.6, specificity 92.5%) with good classification capacity in both the second and third trimesters of gestation. Isthmus <i>z</i>-score and pulmonary/aortic valve ratio increased accuracy in fetuses >28 and tricuspid/mitral valve ratio (TV/MV) in fetuses ≤28 weeks. Study of I/D plus TV/MV ratio in fetuses ≤28 and I/D ratio plus isthmus <i>z</i>-scores in fetuses >28 weeks allowed to correctly classify 91.8% of fetuses as high or low probability of postnatal CoA. <b><i>Conclusions:</i></b> Diagnostic discrimination of anatomic predictive factors for CoA varies according to GA. Specific algorithms according to GA increase accuracy in CoA’s prenatal prediction.

Prenatal diagnosis of hypoplastic aortic arch without intracardiac malformations: The nevada experience

“…The prenatal diagnosis of symptomatic aortic arch hypoplasia is challenging. [11][12][13][14][15] Nevertheless, our results demonstrate that a high prenatal detection percentage in a general population is possible for those requiring surgical repair or an interventional catheterization procedure. Granted, our data does not generate objective prenatal cardiovascular measurements that specifically predict only those needing a therapeutic procedure.…”

“…The prenatal diagnosis of symptomatic aortic arch hypoplasia is challenging 11–15 . Nevertheless, our results demonstrate that a high prenatal detection percentage in a general population is possible for those requiring surgical repair or an interventional catheterization procedure.…”

“…All prenatally diagnosed patients underwent more than one follow‐up fetal echocardiogram by more than one fetal cardiologist with consistent impressions. Nevertheless, others have described risk factors and have developed scores comprised of prenatal fetal echocardiographic morphological features and measurements to predict the presence of a significant neonatal coarctation 11–15 . Additionally, other investigators report the use of fetal magnetic resonance imaging and vascular flow computation, which demonstrated reduced fetal left heart flow is associated with aortic isthmus configurational changes that predispose to significant aortic arch obstruction 14 …”

Subjective and Objective Sonographic Assessment for the Prenatal Detection of Neonatal Coarctation of the Aorta

“…Another promising marker that has been reported in the literature is the isthmus to ductus arteriosus ratio. This marker has been shown in three retrospective studies to have high sensitivity and specificity for the detection of CoA [13, 16, 17]. While we had hoped to assess the aortic isthmus in our study, this was rarely measured within our cohort.…”

Modern Possibilities of Ultrasound Diagnostics of Fetal Heart Defects

“…В то же время отмечается, что конкретные алгоритмы в соответствии с гестационным возрастом повышают точность пренатального прогнозирования коарктации аорты. К таким выводам пришли ученые, изучив в ретроспективном анализе когорту 114 плодов с подозрением на КоА и разработав стратегию серийного тестирования для прогнозирования постнатального КоА с помощью эхокардиографии плода [8].…”