Prediction of coarctation of the aorta in the second half of pregnancy

Gómez-Montes, Enery; Herraı̀z, Ignacio; Mendoza, Alberto; Escribano, David; Galindo, Alberto

doi:10.1002/uog.11228

Cited by 66 publications

(105 citation statements)

References 27 publications

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“…by obtaining the four-chamber view, because examination shows that the right side of the heart is larger than the left and the disproportion is also seen in the great vessels in the mediastinum 4,5,6,7 . The inference is strengthened if there is disproportion between the pulmonary artery and the aorta with the PA/Ao ratio equal to or larger than 1,6 should alert about CoA 8,9 . However, these indicators are not absolutely foolproof 10,11 .…”

Section: Discussionmentioning

confidence: 99%

Original paper. Do Umbilical Cord Wrapped Around the Fetal Body Can Mimic Signs of Aortal Coarctation?

Więckowska

Zych-Krekora

Słodki

et al. 2016

Prenatal Cardiology

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Objectives: Coarctation of the aorta (CoA) is an irreversible congenital heart defect. Its prenatal diagnosis is not rare a subject to false-positive conclusion. We present a novel hypothesis explaining the basis of this error. Methods: Ten cases of prenatal suspicion of the coarctation of the aorta (based on disproportion at the level of 4 chamber view and mediastinum) coincidenced with the umbilical cord wrapped around the fetal body were found in the Filemaker datebase of the Fetal Cardiology Department. Only single pregnancies were taken into account. In all cases another cardiac and extracardiac malformations were excluded. Results: The mean maternal age was 29,6 years. The mean gestational age was 33 7/8 weeks. All fetuses were in a good cardiovascular condition. The usual position of the umbilical cord was neck, but they were also location such as nucha, abdomen or lower limb. At birth, all newborns had normal anatomy of the heart. We conclude that the explanation of the false diagnosis was haemodynamic, resulting from the compression of the fetal neck by the umbilical cord that resulted in a disproportion of cardiac blood flow, “mimicking” CoA. Conclusions: 1. Functional disturbances can mimic prenatal CoA. 2. Umbilical cord position (specially enlacing the fetus neck) should be taken into consideration in suspected cases of fetal CoA.

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Section: Discussionmentioning

confidence: 99%

Original paper. Do Umbilical Cord Wrapped Around the Fetal Body Can Mimic Signs of Aortal Coarctation?

Więckowska

Zych-Krekora

Słodki

et al. 2016

Prenatal Cardiology

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“…However, prenatal diagnosis of coarctation is challenging due to the presence of the ductus arteriosus and limited blood flow across the aortic isthmus in utero [13] . In the United States, fewer than 1 in 4 patients with isolated coarctation requiring neonatal intervention are diagnosed prenatally [15,16] . Moreover, approximately 30% of neonates with coarctation remain undiagnosed upon discharge after delivery [17] .…”

Section: Clinical Presentationmentioning

confidence: 99%

Coarctation of the aorta: Management from infancy to adulthood

Török

Campbell

Fleming

et al. 2015

WJC

234

151

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Coarctation of the aorta is a relatively common form of congenital heart disease, with an estimated incidence of approximately 3 cases per 10000 births. Coarctation is a heterogeneous lesion which may present across all age ranges, with varying clinical symptoms, in isolation, or in association with other cardiac defects. The first surgical repair of aortic coarctation was described in 1944, and since that time, several other surgical techniques have been developed and modified. Additionally, transcatheter balloon angioplasty and endovascular stent placement offer less invasive approaches for the treatment of coarctation of the aorta for some patients. While overall morbidity and mortality rates are low for patients undergoing intervention for coarctation, both surgical and transcatheter interventions are not free from adverse outcomes. Therefore, patients must be followed closely over their lifetime for complications such as recoarctation, aortic aneurysm, persistent hypertension, and changes in any associated cardiac defects. Considerable effort has been expended investigating the utility and outcomes of various treatment approaches for aortic coarctation, which are heavily influenced by a patient's anatomy, size, age, and clinical course. Here we review indications for intervention, describe and compare surgical and transcatheter techniques for management of coarctation, and explore the associated outcomes in both children and adults.

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“…Arch obstruction occurs in the fetus; it is not a postnatal event but a dynamic situation in the fetus [9]. Diagnostic accuracy may be improved by means of combining size-based cardiac parameters with gestational age at diagnosis [10]. Flow disturbance at the isthmus is considered as one of the qualitative diagnostic features of CoAo in the fetuses [6,9,10].…”

Section: Prenatal Predictionmentioning

confidence: 99%

“…Diagnostic accuracy may be improved by means of combining size-based cardiac parameters with gestational age at diagnosis [10]. Flow disturbance at the isthmus is considered as one of the qualitative diagnostic features of CoAo in the fetuses [6,9,10]. It is known description of flow disturbance as a delayed flow through aortic isthmus.…”

Section: Prenatal Predictionmentioning

confidence: 99%

“…This leads to increased morbidity and mortality in affected neonates without correct prenatal diagnosis, who often collapse and require resuscitation before surgery [2,4,5] and unjustified costs of cardiac centers due to false-positive cases [6]. Despite advances in fetal echocardiography and the description of antenatal findings associated with neonatal CoAo, this lesion remains the most challenging diagnosis to be made in fetal and early neonatal life [6][7][8][9][10].To the best of our knowledge quantitative fetal Doppler criteria of neonatal CoAo have not been described in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Fetal Doppler Predictor of Neonatal Coarctation of the Aorta

Ostras¹

2015

JCCR

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Objective: To describe fetal quantitative Doppler predictor of neonatal Coarctation of the aorta (CoAo). Methods:We retrospectively selected all cases of prenatal CoAo suspicion between December 2012 and August 2014 at the Fetal Cardiology Unit, Ukrainian Children's Cardiac Center, Kyiv, Ukraine. Only fetuses with suspicion of isolated CoAo and complete follow-up were included in the study. Sixty six (66) cases were analyzed. Echocardiographic parameters obtained after 32 gestational weeks were compared in true and false-positive groups. Optimal cut-off for the isthmic-ductal diastolic flow indices difference (IDDFID) was identified and the corresponding likelihood ratios used to calculate the post-test probability of CoAo in each fetus. Results:CoAo was confirmed in 44/66 cases (66.7%). After 32 weeks of gestation cut-off value of the IDDFID was ≥ 0.2. The mean post-test probabilities of CoAo were higher in fetuses with confirmed CoAo than in fetuses with false suspicion (85 vs 30%; P<0.0001). Conclusion:We have described fetal quantitative Doppler criterion which is a step to objectivization of assessment of aortic isthmus flow disturbance and improvement of the accuracy of fetal echocardiography for prediction of neonatal CoAo. KeywordsCoarctation of the aorta; Fetal echocardiography; Doppler Fetal Doppler Predictor of Neonatal Coarctation of the Aorta Research Article Materials and Methods Prenatal dataRetrospective study was performed at a tertiary care center (Ukrainian Children's Cardiac Center, Kyiv, Ukraine). All cases of prenatal suspicion of CoAo were selected from Fetal Cardiology Unit computerized database in the period from December 2012 till August 2014. Echocardiographic examinations were performed with a Philips iU22 machine (Philips Ultrasound, Bothell, WA) with C5-1 transabdominal transducer and recorded on digital storage. All analyzed prenatal information was obtained from examinations after 32 weeks of gestation. Gestational age was calculated from the last menstrual period, confirmed by first-trimester scan. The suspicion of fetal CoAo was based on aortic isthmus Z-score <-2 SD, isthmus-to-duct Z-score <-2 SD and right-to-left heart structures ratio more than 1.6. Fetuses with persistent left superior vena cava were included. The cases of combined major intracardiac anomalies, such as significant ventricular septal defect, subvalvar aortic stenosis were excluded. The study was approved by Center Ethics Committee.Fetal ultrasound examinations included a detailed echocardiography [11]. Cardiac dimensions were measured from inner edge to inner edge. The aortic isthmus dimension was measured immediately proximal to the insertion of the arterial duct in the three vessels and trachea (3VT) view. The ductal diameter was measured in the same view [8]. The cardiac measurements were performed during echocardiography and appropriate Z-scores were calculated using existing equations

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Prediction of coarctation of the aorta in the second half of pregnancy

Abstract: Objective To determine which combination of cardiac parameters provides the best prediction of postnatal coarctation of the aorta (CoAo) (20% CoAo (9/45)

Cited by 66 publications

References 27 publications

Original paper. Do Umbilical Cord Wrapped Around the Fetal Body Can Mimic Signs of Aortal Coarctation?

Original paper. Do Umbilical Cord Wrapped Around the Fetal Body Can Mimic Signs of Aortal Coarctation?

Coarctation of the aorta: Management from infancy to adulthood

Fetal Doppler Predictor of Neonatal Coarctation of the Aorta

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