Utility of novel fetal echocardiographic morphometric measures of the aortic arch in the diagnosis of neonatal coarctation of the aorta

Arya, Bhawna; Bhat, Aarti; Vernon, Margaret M.; Conwell, Jeffrey; Lewin, Mark B.

doi:10.1002/pd.4753

Cited by 59 publications

(70 citation statements)

References 21 publications

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“…Our study showed that fetuses with postnatally confirmed CoA exhibited significantly smaller left cardiac structures and diameters of the isthmic region normalized for gestational age. The best Z-scores for prediction of postnatal CoA were those of the MV-annulus, ascending aorta, and isthmus aortae in the sagittal or 3VT views, which have been described in other studies [6,[20][21][22][23][24]. Most studies to date have used Z-scores from Pasquini et al for isthmic or ductal diameters and Schneider et al for intracardiac structures or the ascending aorta, often with a pre-defined cut-off point of < −2 [15,16].…”

Section: Z-scoressupporting

confidence: 70%

Fetal Echocardiographic Dimension Indices: Important Predictors of Postnatal Coarctation

2020

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The aim of the study is to identify reliable quantitative fetal echocardiographic predictors for postnatal development of coarctation (CoA). In this retrospective study, we included 65 fetuses with a prenatally suspected, isolated CoA, born 2010–2018. Dimensions of the cardiac structures, aortic, and ductal arches expressed as ratios and Z-scores were analyzed in relation to outcome. Fetuses that developed CoA postnatally (34%) exhibited significantly smaller Z-scores of left cardiac structures from the mitral valve to the aortic isthmus. The most sensitive and specific predictors were a carotid-subclavian artery index (CSAI) of < 0.78 (92.3% sensitivity, 96.8% specificity) or a product of isthmus-to-duct ratio in the three-vessel trachea view (3VT) and the mitral-to-tricuspid valve ratio (I/D3VTxMV/TV) of < 0.37 (100% sensitivity, 94.6% specificity). When comparing different Z-score datasets, we observed large and highly significant differences. Postnatal CoA can be predicted with high accuracy during fetal life using CSAI or I/D3VTxMV/TV. The latter may be particularly useful if adequate sagittal aortic arch images cannot be obtained. As significant and clinically unacceptable differences in Z-scores were observed for the same measurements, this calls for a large multi-center collaboration to generate reliable fetal echocardiographic Z-scores.

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Section: Z-scoressupporting

confidence: 70%

Fetal Echocardiographic Dimension Indices: Important Predictors of Postnatal Coarctation

2020

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“…Similarly, only 1 study had more control fetuses (n = 285) than ours (n = 200). The only measurements from their review that overlapped with our data were the RV/LV end-diastolic diameter ratio reported by Mărginean et al [24] in 2015 and Arya et al [25] in 2016, and the RV/LV end-diastolic area ratio reported by Toole et al [26] in 2015 and Arya et al [25]. Our analysis demonstrated that these ratios were present in 70-84% of fetuses with CoA compared to 5% of the control fetuses, and had the strongest associations compared to the other global and ventricular markers evaluated.…”

Section: Discussionmentioning

confidence: 49%

Aortic Coarctation: A Comprehensive Analysis of Shape, Size, and Contractility of the Fetal Heart

et al. 2019

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Background: An integrated assessment of the size and shape of the 4-chamber view (4-CV) and right and left ventricles (RV and LV) as well as the function of the RV and LV in fetuses with coarctation of the aorta (CoA) has not yet been conducted. Objectives: We evaluated the size and shape of the 4-CV, RV, and LV, and function of the RV and LV, to identify a profile for fetuses with CoA when compared to a control population. Methods: 50 CoA fetuses were compared to 200 controls. This was a retrospective case series comparing the 4-CV of CoA fetuses and controls. The 4-CV end-diastolic area, length, width, and sphericity index were measured to determine the configuration of the 4-CV. Speckle-tracking analysis was used to compute the RV and LV end-diastolic area, length, 24-segment sphericity index, 24-segment transverse width, and the following functional parameters:(1) fractional area change; (2) global, lateral, and septal strain;(3) basal-apical, lateral, and septal annular displacement and fractional shortening; and (4) 24-segment transverse width fractional shortening. Using 5 and 95% reference intervals, the CoA fetal measurements were classified; from these, the odds ratio was computed between the fetuses with CoA and the controls. p < 0.05 was considered significant. Results: In fetuses with CoA, the 4-CV was spherical in shape, increased in area and width, and decreased in length. Abnormal CoA sphericity indices reflected a flatter LV and a more spherical RV. The LV area, length, and width, and RV length were decreased. The transverse width of the RV was increased. RV and LV global, longitudinal, and transverse contractility were depressed. Conclusions: The results demonstrate previously unappreciated differences in the shape, size, and function of the heart in fetuses with CoA. These differences may assist examiners in identifying fetuses with CoA.

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“…The central axis of the lumen of the fetal DA, where the blood flow is fastest, is not included in the 3VT view where the classic 'V-like' sign is formed by the pulmonary artery and the aortic arch, and the DA seen from the 3VT view is actually the upper part of the fetal DA lumen. Furthermore, physiologically, the angle between the DA and the descending aorta (DAO, 98.4±12.5˚) is significantly larger than that between the aortic arch and the DAO (88.5±5.5˚) (18)(19)(20). Since the 3VT view is obtained in the horizontal direction of the fetal body, the angle between the DA and DAO is relatively large, thereby reducing the probability of forming the smallest angle between the DA and the ultrasound beam compared with that including the aortic arch.…”

Section: Discussionmentioning

confidence: 99%

Variations in ductus arteriosus Doppler parameters in different sonographic views during the second half of gestation

et al. 2018

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The aim of the present study was to compare the Doppler parameters of the fetal ductus arteriosus (DA) measured in the traditional longitudinal ductal arch (LDA) view and the newly introduced three vessels and trachea (3VT) plane of the fetal upper mediastinum. The peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged maximum velocity (TAMXV) and velocity-time integral (VTI) measurements were taken for 52 fetuses with normal growth (including 29 females). The pulsatility index (PI) and resistance index (RI) were calculated. All parameters for each fetus were measured three times by the same sonographer in the LDA and the 3VT view, and the averages were taken to obtain the final value. Differences in the above values obtained from the LDA and 3VT views were analyzed and the correlation between the differences of all indices and the gestational age (GA) was evaluated using Pearson's linear coefficient of correlation. All of the values were characterized as normally distributed continuous variables by homogeneity of variance analysis. Slight increases in the PSV, EDV, TAMXV and VTI determined in the LDA view were identified compared with those in the 3VT view (P<0.05). Furthermore, these increases were identified to be independent of the GA (P>0.05). However, no significant differences in the impedance indices PI and RI were observed between the two sonographic planes (P>0.05). In conclusion, the LDA view provides a better chance than the 3VT view to obtain higher values of velocity parameters (PSV, EDV, TMAXV and VTI) within the fetal DA, and the differences are independent of the GA. However, no significant variations in the impedance indices PI and RI were observed between these two sonographic planes.

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Utility of novel fetal echocardiographic morphometric measures of the aortic arch in the diagnosis of neonatal coarctation of the aorta

Abstract: Fetal LCSA, AAo-DAo angle, and TAo-DAo angles are novel measures that can differentiate between subjects with and without CoA.

Cited by 59 publications

References 21 publications

Fetal Echocardiographic Dimension Indices: Important Predictors of Postnatal Coarctation

Fetal Echocardiographic Dimension Indices: Important Predictors of Postnatal Coarctation

Aortic Coarctation: A Comprehensive Analysis of Shape, Size, and Contractility of the Fetal Heart

Variations in ductus arteriosus Doppler parameters in different sonographic views during the second half of gestation

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