Fetal Echocardiographic Dimension Indices: Important Predictors of Postnatal Coarctation

Abstract

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.

Application of a Global Multiparameter Scoring System for the Prenatal Prediction of Coarctation of the Aorta

“…In previous studies [20], it has been observed that the peak transaortic velocity is significantly greater in those fetuses in which CoAo is confirmed after birth and require surgery. In the same way, a bidirectional or left-right interatrial shunt and a bidirectional/retrograde flow at the aortic arch have been reported more frequently in fetuses with CoAo, but with a low specificity [33]. However, as in our series, other studies did not observe differences for functional parameters (flow at the aortic arch and FO) between CoAo and no CoAo fetuses [18,20,24].…”

“…However, as in our series, other studies did not observe differences for functional parameters (flow at the aortic arch and FO) between CoAo and no CoAo fetuses [18,20,24]. We also did not find differences for PLSVC according to postanal outcome (CoAo vs. no CoAo), similarly to other groups [18,22,24,25,33]. Nevertheless, Morgan et al [20] found more cases of PLSVC in fetuses with CoAo compared to normal cases, although in the multivariate analysis, it was not statistically significant.…”

“…Recent studies have proposed some morphological and functional fetal echocardiographic parameters, and even multiparameter scoring systems in order to improve the prenatal prediction of the likelihood of postnatal confirmation of CoAo [18][19][20][21][22][23][24][25][30][31][32][33]. The current study is the largest to prospectively assess the capability of a multiparameter scoring system to predict CoAo in fetuses with ventricular and great vessel disproportion with right dominance.…”

“…Table 4 summarizes the echocardiographic variables and multiparameter scores proposed by several groups for prenatal prediction of CoAo [18][19][20][21][22][23][24][25][30][31][32][33]. Our global score includes three cardiac parameters (Z-score of the AAo and of the aortic isthmus in the 3VT view, and the PV/AV ratio), and GA at diagnosis.…”

“…Previous studies have described some morphologic and functional cardiac parameters that could be useful to obtain a better prenatal prediction of CoAo [21,[29][30][31]. In addition, over the last few years, several multiparameter scoring systems to differentiate between subjects with and without CoAo have been published [18][19][20][21][22][23][24][25]30,32,33]. However, there are few groups that have applied these scores to clinical practice to distinguish fetuses with and without CoAo.…”