Prenatal Sonographic Predictors of Neonatal Coarctation of the Aorta

Abstract

Objectives To identify practical prenatal sonographic markers for the postnatal diagnosis of coarctation of the aorta. Methods We reviewed the fetal echocardiograms and postnatal outcomes of fetal cases of suspected coarctation of the aorta seen at a single institution between 2010 and 2014. True‐ and false‐positive cases were compared. Logistic regression analysis was used to determine echocardiographic predictors of coarctation of the aorta. Optimal cutoffs for these markers and a multivariable threshold scoring system were derived to discriminate fetuses with coarctation of the aorta from those without coarctation of the aorta. Results Among 35 patients with prenatal suspicion of coarctation of the aorta, the diagnosis was confirmed postnatally in 9 neonates (25.7% true‐positive rate). Significant predictors identified from multivariate analysis were as follows: Z score for the ascending aorta diameter of −2 or less (P = < .001), Z score for the mitral valve annulus of −2 or less (P= .033), Zscore for the transverse aortic arch diameter of −2 or less (P= .028), and abnormal aortic valve morphologic features (P= .026). Among all variables studied, the ascending aortic Z score had the highest sensitivity (78%) and specificity (92%) for detection of coarctation of the aorta. A multivariable threshold scoring system identified fetuses with coarctation of the aorta with still greater sensitivity (89%) and only mildly decreased specificity (88%). Conclusions The finding of a diminutive ascending aorta represents a powerful and practical prenatal predictor of neonatal coarctation of the aorta. A multivariable scoring system, including dimensions of the ascending and transverse aortas, mitral valve annulus, and morphologic features of the aortic valve, provides excellent sensitivity and specificity. The use of these practical sonographic markers may improve prenatal detection of coarctation of the aorta.

Twenty‐four Segment Transverse Ventricular Fractional Shortening: A New Technique to Evaluate Fetal Cardiac Function

“…The fetus with coarctation of the aorta showed depression of fractional shortening at the base of both the right and left ventricles as well as depression of the mid and apical sections of the left ventricle. Right ventricular involvement could be secondary to volume overload of the ventricle, which is often observed in coarctation of the aorta, whereas depression of contractility of the left ventricle was secondary to an increased afterload from the anatomic malformation of the left outflow tract and aortic arch as well as decreased resistance in the brain, as manifested by increased blood flow (abnormal middle cerebral artery Doppler findings; Table ) …”

“…Right ventricular involvement could be secondary to volume overload of the ventricle, which is often observed in coarctation of the aorta, whereas depression of contractility of the left ventricle was secondary to an increased afterload from the anatomic malformation of the left outflow tract and aortic arch as well as decreased resistance in the brain, as manifested by increased blood flow (abnormal middle cerebral artery Doppler findings; Table 5). 46 Assessment of the fractional shortening of the ventricular chambers is one component of fetal cardiovascular evaluation when anatomic or functional cardiovascular malformations are suspected. When substantial changes in fractional shortening occur, the clinician should consider using other diagnostic tools to further evaluate the fetal heart.…”

Evaluation of Fetal Left Ventricular Size and Function Using Speckle‐Tracking and the Simpson Rule

“…D ifferences in left ventricular (LV) and right ventricular (RV) size and function have been reported in various fetal disease states. [1][2][3][4] In prior studies, we have reported using speckle-tracking software to evaluate various parameters of the fetal LV and RV, including the area, 24-segment transverse widths, 24-segment transverse fractional shortening, fractional area change, as well as longitudinal basal-apical contractility and displacement. [5][6][7][8] These measurements reported from our group have not yet been applied postnatally.…”

Modeling of coarctation of aorta in human fetuses using 3D/4D fetal echocardiography and computational fluid dynamics

“…[1][2][3][4] In addition, the etiology and pathophysiology of CoA are, to some extent, putative, mostly related to the CHD with reduced flow across the aortic isthmus prenatally and/or the migration and contraction of the ductal tissue and closure of the patent ductus arteriosus postnatally. [1][2][3][4] In addition, the etiology and pathophysiology of CoA are, to some extent, putative, mostly related to the CHD with reduced flow across the aortic isthmus prenatally and/or the migration and contraction of the ductal tissue and closure of the patent ductus arteriosus postnatally.…”

“…Although there is significant progress in prenatal diagnosis in many types of CHD, fetal diagnosis of CoA remains a challenge. [1][2][3][4] In addition, the etiology and pathophysiology of CoA are, to some extent, putative, mostly related to the CHD with reduced flow across the aortic isthmus prenatally and/or the migration and contraction of the ductal tissue and closure of the patent ductus arteriosus postnatally. One of the challenges of the investigation of these important areas is the lack of robust and quantitative methodology to evaluate the hemodynamics of the flow and related variables in the aortic and ductal arches.…”