Sonographic predictors of surgery in fetal coarctation of the aorta

Jowett, Victoria; Aparicio, Pilar; Santhakumaran, Shalini; Seale, Anna; Jičínská, Hana; Gardiner, Helena M.

doi:10.1002/uog.11161

Cited by 71 publications

(92 citation statements)

References 16 publications

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“…The reference ranges for cardiac outflow tracts and z scores presented in this study can be applied in the assessment of patients with cardiac asymmetry, pulmonary stenosis, right ventricular outflow tract obstruction, or aortic stenosis 2,3,5,10,11,13,15,16,18,[24][25][26][27][28][29][30][31][32] ; in these cases knowledge of the accurate z score can aid in predicting the need for neonatal intervention and to plan perinatal management. Z scores may also be useful in forecasting the natural history of valve stenosis and in designing clinical trials on the value of in utero valvuloplasty, where patients can be stratified according to z scores.…”

Section: Potential Rhythm Disturbance 90mentioning

confidence: 99%

Reference Ranges for the Size of the Fetal Cardiac Outflow Tracts From 13 to 36 Weeks Gestation

Vigneswaran

Akolekar

Syngelaki

et al. 2018

Circ: Cardiovascular Imaging

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Background: Assessment of the outflow tract views is an integral part of routine fetal cardiac scanning. For some congenital heart defects, notably coarctation of the aorta, pulmonary valve stenosis, and aortic valve stenosis, the size of vessels is important both for diagnosis and prognosis. Existing reference ranges of fetal outflow tracts are derived from a small number of cases. Methods and Results: The study population comprised 7945 fetuses at 13 to 36 weeks’ gestation with no detectable abnormalities from pregnancies resulting in normal live births. Prospective measurements were taken of (1) the aortic and pulmonary valves in diastole at the largest diameter with the valve closed, (2) the distal transverse aortic arch on the 3 vessel and trachea view beyond the trachea at the distal point at its widest systolic diameter, and (3) the arterial duct on the 3 vessel and trachea view at its widest systolic diameter. Regression analysis, with polynomial terms to assess for linear and nonlinear contributors, was used to establish the relationship between each measurement and gestational age. The measurement for each cardiac diameter was expressed as a z score (difference between observed and expected value divided by the fitted SD corrected for gestational age) and percentile. Analysis included calculation of gestation-specific SDs. Regression equations are provided for the cardiac outflow tracts and for the distal transverse aortic arch:arterial duct ratio. Conclusions: The study established reference ranges for fetal outflow tract measurements at 13 to 36 weeks’ gestation that are useful in clinical practice.

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Section: Potential Rhythm Disturbance 90mentioning

confidence: 99%

Reference Ranges for the Size of the Fetal Cardiac Outflow Tracts From 13 to 36 Weeks Gestation

Vigneswaran

Akolekar

Syngelaki

et al. 2018

Circ: Cardiovascular Imaging

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“…On the contrary, CoAo in fetal life is often considered a ‘uniform' condition in which only the diagnosis of ‘suspicion' can be made, and most cases usually undergo the same management pathway, thus not giving the parents individualized information regarding the more likely outcome for their fetus [38,39]. Recent studies have shown a relationship between prenatally measured Z-score of the aortic isthmus and the likelihood of surgery in suspected CoAo [19,20]. We have moved forward with this study showing firstly that patients with prenatally suspected CoAo requiring median sternotomy for CoAo repair have significantly smaller Z-score values of the aortic isthmus in sagittal view when compared with those who are repaired through left thoracotomy, and secondly that following two-step assessment, in fetuses in whom detailed echocardiography has previously showed that have the higher risk of truly having CoAo, this single parameter may be applied prenatally to predict their more likely surgical approach for CoAo repair with a high degree of accuracy (sensitivity of 78% and specificity of 82% for predicting sternotomy approach).…”

Section: Discussionmentioning

confidence: 99%

“…Recent papers have shown that some direct size-based and functional fetal echocardiographic parameters may be useful to predict better the likelihood that CoAo will be confirmed or not postnatally [19,20,21], but the prediction of the more likely surgical approach for CoAo is rarely aimed prenatally. This study evaluates the capacity of fetal echocardiography to predict this important issue.…”

Section: Introductionmentioning

confidence: 99%

Prenatal Prediction of Surgical Approach for Coarctation of the Aorta Repair

Gómez-Montes

Herraı̀z²,

Mendoza³

et al. 2013

Fetal Diagn Ther

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Objective: To evaluate the capacity of fetal echocardiography for predicting the more likely surgical approach in newborns with coarctation of the aorta (CoAo) (left thoracotomy vs. median sternotomy). Material and Methods: We selected all cases of suspected CoAo prenatally diagnosed in 2003-2012 (n = 95). 49/95 were considered at high-risk and 46/95 at low-risk of CoAo, and 38/49 and 7/46 were postnatally confirmed, respectively. We firstly evaluated in 40 cases of CoAo surgically repaired (24 thoracotomy, 16 sternotomy) whether there were differences in fetal echocardiographic parameters between both groups. Secondly, we assessed the performance of these parameters for predicting the surgical approach in fetuses at high risk of CoAo. Results: Sternotomy approach was associated with higher rate of postoperative complications and longer hospital stay compared with thoracotomy (81.3 vs. 41.7%, p = 0.014; 30.5 vs. 15.4 days, p = 0.0004, respectively). The Z-score of the aortic isthmus, measured in the sagittal plane, was significantly smaller in the sternotomy group. In fetuses at high-risk of having CoAo a cut-off value of the isthmus Z-score ≤ -2.5 had sensitivity of 78% and specificity of 82% for predicting sternotomy approach, with 9% false positive cases in which CoAo was not confirmed. Discussion: The surgical approach for CoAo repair may be prenatally predicted by means of the Z-score of aortic isthmus, measured in the sagittal plane.

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“…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%

“…Currently prenatal diagnosis of this condition lacks sensitivity at screening and specificity even when performed by experts in tertiary centers. 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%

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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Sonographic predictors of surgery in fetal coarctation of the aorta

Abstract: Objectives 22.4 (range. 16.6-7.0) weeks and the median number of scans per fetus was three (range, one to five). I < −2 at final scan was the most powerful predictor (odds ratio, 3.6 (95% CI,). Shelf was identified in 66% and Flow in 50% of fetuses with CoA.

Cited by 71 publications

References 16 publications

Reference Ranges for the Size of the Fetal Cardiac Outflow Tracts From 13 to 36 Weeks Gestation

Reference Ranges for the Size of the Fetal Cardiac Outflow Tracts From 13 to 36 Weeks Gestation

Prenatal Prediction of Surgical Approach for Coarctation of the Aorta Repair

Fetal Doppler Predictor of Neonatal Coarctation of the Aorta

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