Improving Prenatal Diagnosis of Coarctation of the Aorta

Morgan, Conall T.; Mueller, Brigitte; Thakur, Varsha; Guerra, Vitor; Jull, Callaghan; Mertens, Luc; Friedberg, Mark K.; Golding, Fraser; Seed, Mike; Miner, Steven E.S.; Jaeggi, Edgar; Manlhiot, Cedric; Nield, Lynne E.

doi:10.1016/j.cjca.2018.12.019

Cited by 15 publications

(32 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, the association between the flow direction across the atrial septum or in the aortic arch and postnatal CoA has been reported [22,23]. However, in our study, they had a relatively low specificity of 65-75%, leading in some cases to the misjudgment by the fetal cardiologist that there might exist high risk for postnatal CoA or even univentricular outcome, if the flow direction was bidirectional or left-right at the atrial level or bidirectional in the aortic arch.…”

Section: Ratioscontrasting

confidence: 50%

“…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-scoresmentioning

confidence: 71%

See 1 more Smart Citation

Fetal Echocardiographic Dimension Indices: Important Predictors of Postnatal Coarctation

2020

View full text Add to dashboard Cite

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.

show abstract

Section: Ratioscontrasting

confidence: 50%

Section: Z-scoresmentioning

confidence: 71%

Fetal Echocardiographic Dimension Indices: Important Predictors of Postnatal Coarctation

2020

View full text Add to dashboard Cite

show abstract

“…The positive predictive value of this cardiac asymmetry varies from 60% to 86% in the second trimester and decreases to 10-41% in the third trimester [1,7,11,13,14], because this finding could appear in fetuses without CoAo in late pregnancy [15]. Consequently, more than 50-60% of cases with a prenatal suspected CoAo are not confirmed after birth, but they are recommended to be delivered at tertiary hospitals [7,[16][17][18][19][20][21][22][23][24][25][26]. An improvement in survival, morbidity, and perioperative conditions when the CoAo is prenatally diagnosed by enabling planned delivery in an adequate center and the early prevention of a ductus arteriosus (DA) constriction has been reported [27,28].…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Gómez-Montes

Herraı̀z

Escribano

et al. 2021

JCM

View full text Add to dashboard Cite

To assess prospectively the capability of our previously reported global multiparameter scoring system to predict coarctation of the aorta (CoAo) in fetuses with cardiac asymmetry, we applied and analyzed the performance of our scoring system in predicting postnatal CoAo in fetuses undergoing prenatal echocardiographic assessment because of cardiac asymmetry between 2011 and 2021, and we determined the cut-off points of the score with the best balance between specificity and sensitivity, and of maximum sensitivity and specificity. CoAo was confirmed in 39/179 newborns (21.8%). We found a significantly higher probability of CoAo in fetuses with CoAo than in cases without CoAo (84.2 ± 18.2% vs. 26.0 ± 28.6%, p < 0.001). The AUC of the ROC of the score was 0.93 (95% CI 0.89–0.97). The cut-off value with the best balance between specificity and sensitivity was a predicted risk of ≥53% (sensitivity 92.3% and specificity 80.0%). The cut-off point of maximum sensitivity was ≥35% (sensitivity 100% and specificity 72.9%), and that of maximum specificity was ≥96% (sensitivity 43.6% and specificity 96.4%). In none of the fetuses with a probability of CoAo < 35% was this condition confirmed after birth. This occurred in 102 fetuses in the whole study population (57%) and in 84 of the 111 in whom CoAo was suspected beyond 28 weeks (75.7%). This multiparameter score allows an adequate discrimination between fetuses without CoAo and those with CoAo, reducing the false positive diagnoses in cardiac asymmetry.

show abstract

“…Recent data on cardiovascular adaptation during neonatal life suggest that, despite biventricular remodeling and cardiac output redistribution, fetuses with CoA have no significant myocardial dysfunction 43 . Regarding the postnatal prognosis of CoA, the variables associated with intervention comprised smaller AAo and transverse arch size, earlier gestational age at diagnosis, and the additional finding of a higher peak AAo Doppler 44 . Confirmed cases of CoA must be followed closely over the lifetimes of affected newborns for complications such as recoarctation, aortic aneurysm, persistent hypertension, and changes in any associated cardiac defects 45 …”

Section: Coarctation Of the Aortamentioning

confidence: 99%

A “holistic” sonographic view on congenital heart disease: How automatic reconstruction using fetal intelligent navigation echocardiography eases unveiling of abnormal cardiac anatomy part II—Left heart anomalies

Weichert

2021

Echocardiography

View full text Add to dashboard Cite

Volume ultrasound has been shown to provide valid complementary information on fetal anatomy. Four‐dimensional assessment (4D) of the fetal cardiovascular system using spatial–temporal image correlation (STIC) allows for detailed examination of a highly complex organ from the early second trimester onward. There is compelling evidence that this technique harbors quite a number of diagnostic opportunities, but manual navigation through STIC volume datasets is highly operator dependent. In fact, STIC is not incorporated yet into daily practice. Application of the novel fetal intelligent navigation echocardiography (FINE) considerably simplifies fetal cardiac volumetric examinations. This automatic technique applied on cardiac volume datasets reportedly has both high sensitivity and specificity for the detection of congenital heart defects (CHDs). Part I reviewed current data regarding detection rates of CHDs and illustrated the additional value of an automatic approach in delineating cardiac anatomy exemplified by congenital lesions of the right heart. In part II of this pictorial essay, we focused on left heart anomalies and aimed to tabulate recent findings on the quantification of normal and abnormal cardiac anatomy.

show abstract

Improving Prenatal Diagnosis of Coarctation of the Aorta

Cited by 15 publications

References 29 publications

Fetal Echocardiographic Dimension Indices: Important Predictors of Postnatal Coarctation

Fetal Echocardiographic Dimension Indices: Important Predictors of Postnatal Coarctation

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

A “holistic” sonographic view on congenital heart disease: How automatic reconstruction using fetal intelligent navigation echocardiography eases unveiling of abnormal cardiac anatomy part II—Left heart anomalies

Contact Info

Product

Resources

About