Prenatal diagnosis of coarctation of the aorta improves survival and reduces morbidity

Abstract

Objective: To investigate whether antenatal diagnosis of coarctation of the aorta results in reduced mortality and improved preoperative haemodynamic stability compared with postnatal diagnosis. Design: Retrospective review of all cases of coarctation of the aorta presenting to a tertiary fetal and neonatal cardiology service from January 1994 to December 1998. Methods: Prenatal, postnatal, and necropsy records were reviewed to determine survival in the two groups. Markers of preoperative illness severity were recorded, including presence of femoral pulse, collapse, left ventricular function, ductal patency on echocardiography, coagulation status, duration of intensive care unit and total hospital stay, heart rate, respiratory rate, plasma creatinine, plasma potassium, and right upper limb blood pressure. A univarate and multivariate analysis was conducted on all variables and a cumulative score was created and subjected to logistic regression analysis. Results: Both collapse and death were more common in the postnatally diagnosed group (p < 0.05). Femoral pulses were more likely to be palpable and there was echocardiographic evidence of duct patency in the antenatally diagnosed infants (p < 0.001 and p < 0.05, respectively). An increased respiratory rate was associated with postnatal presentation (p < 0.05). Infants with haemodynamic instability preoperatively were more likely to have been diagnosed postnatally (p < 0.01). Conclusions: Antenatal diagnosis of coarctation of the aorta is associated with improved survival and preoperative clinical condition. P renatal diagnosis of coarctation of the aorta has been possible for over 12 years.1 It can, however, be a difficult diagnosis to make, as evidenced by the number of false positive and false negative diagnoses, even in the best centres.2 Postnatally, coarctation often presents with cardiovascular collapse and acidosis as the arterial duct closes. Early diagnosis of coarctation should therefore improve preoperative haemodynamic stability with its associated risk of neurodisability and early neonatal death. Previous studies of coarctation 3 4 have not shown improved survival as a result of antenatal diagnosis but have suggested that the preoperative cardiovascular stability of affected infants is improved. These studies have examined coarctation as part of a group of mixed diagnoses and did not study necropsy cases. We therefore undertook a retrospective review of prenatally suspected coarctation to see whether the outcome was significantly better in this group than in infants diagnosed for the first time postnatally. METHODSWe included all cases of neonatal coarctation presenting to our cardiology department over a five year period from 1994. Prenatal, postnatal, and necropsy case records were reviewed. Outcome variables are shown in table 1. These were selected to assess the illness severity and were available in all cases. The acid-base status was not checked routinely on all neonates if they were considered to be in good or excellent condition, and these da...

Prenatal detection of congenital heart disease—results of a national screening programme

“…[15][16][17][18][19]37 In this study, the first-year mortality, as well as the presurgical mortality in liveborn infants with isolated severe CHD, remained similar.…”

“…7,[10][11][12][13][14] Prenatal detection of specific types of CHD may reduce neonatal mortality and morbidity. [15][16][17][18][19] It allows for planning the delivery at a tertiary-care centre ensuring optimal neonatal and perisurgical care. Furthermore, parents can consider termination of pregnancy (TOP) in severe cases.…”

Four-dimensional fetal echocardiography with spatiotemporal image correlation (STIC): A systematic study of standard cardiac views assessed by different observers

“…Prenatal diagnosis of congenital heart disease is associated with improvement in neonatal morbidity and mortality for the following conditions: transposition of the great arteries [3], hypoplastic left heart syndrome [4,5] and coarctation of the aorta [6]. However, the diagnostic accuracy for prenatal diagnosis of congenital heart disease is limited .…”

Fetal “Aortic Coarctation” and Different Neonatal Follow-Up in 3 Cases

“…We also believe that it is worth to make longitudinal observations in cases of false (+) prenatal diagnoses (based on case nr 3). Despite good statistical studies we are still observing false positive diagnosis in the clinical practice so every patient needs to be treated individually 22 …”