Iranian Journal of Neonatology

Iranian Journal of Neonatology

Comparison of Diagnostic Markers of Aortic Coarctation in Prenatal and Postnatal Echocardiography

Document Type : Original Article

Authors
Narges Afzali 1
hassan Birjandi 2
Abdolreza Malek 3
Homa Mohammadi 4
Mohammadreza Moradi 5
1 Department of Radiology, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
2 Department of Pediatric Heart Disease, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3 Department of Pediatric Rheumatology, Faculty of Medicine, Mashhad University of Med‌ical Sciences, Mashhad, Iran
4 Faculty of Medicine, Mashhad Medical Sciences ,Islamic Azad University, Mashhad, Iran
5 Radiology clinic of Nasl-e-Omid
10.22038/ijn.2022.64539.2248
Abstract
Background: The prenatal diagnosis of coarctation of aorta (CoA) remains a major challenge, as the false-positive diagnosis is fairly common. The purpose of this study was to find some useful prenatal sonographic markers compatible with the postnatal diagnosis of CoA.
Methods: The study included fetuses suspected of CoA in the second and third-trimester ultrasound tests. All cases were examined by fetal echocardiography at a single ultrasound clinic between 2019 and 2020. The proportion of right and left ventricular size was assessed and ductal/isthmus diameter ratio was measured. A comparison was drawn between the results of neonates with neonatal CoA and neonates without CoA.
Results: Of 20 fetuses with suspected prenatal CoA, 3 (15%) had neonatal CoA. The mean ductal/isthmus ratio was significantly higher in the neonates with CoA (1.96 vs. 1.46; p< 0.001). The diagnostic power of ductal/isthmus ratio to detect CoA with a cut point of 1.53 had a sensitivity and specificity of 100% and 70.6%, respectively, a positive and negative predictive value of 37.5% and 100%, respectively, and an overall accuracy of 75%.
Conclusion: The ductal/isthmus ratio diameter and ventricular disproportion are significant sonographic markers for the prenatal diagnosis of CoA, and the ductal/isthmus ratio has high sensitivity and specificity compared to postnatal findings.
 
 
Keywords
Aortic coarctation
Fetal echocardiography
Prenatal diagnosis
  1. Rao PS. Neonatal (and Infant) coarctation of the aorta: management challenges. Res Rep Neonatol. 2020; 10:11.
  2. Hede SV, DeVore G, Satou G, Sklansky M. Neonatal management of prenatally suspected coarctation of the aorta. Prenat Diagn. 2020;40(8):942–8.
  3. Contro E, Cattani L, Balducci A, Prandstraller D, Perolo A, Larcher L, et al. Prediction of neonatal coarctation of the aorta at fetal echocardiography: a scoring system. J Matern Fetal Neonatal Med. 2020;1–10.
  4. Morgan CT, Mueller B, Thakur V, Guerra V, Jull C, Mertens L, et al. Improving prenatal diagnosis of coarctation of the aorta. Can J Cardiol. 2019;35(4):453–61.
  5. Franklin O, Burch M, Manning N, Sleeman K, Gould S, Archer N. Prenatal diagnosis of coarctation of the aorta improves survival and reduces morbidity. Heart. 2002;87(1):67–9.
  6. Familiari A, Morlando M, Khalil A, Sonesson S-E, Scala C, Rizzo G, et al. Risk factors for coarctation of the aorta on prenatal ultrasound: a systematic review and meta-analysis. Circulation. 2017;135(8):772–85.
  7. Jowett V, Aparicio P, Santhakumaran S, Seale A, Jicinska H, Gardiner HM. Sonographic predictors of surgery in fetal coarctation of the aorta. Ultrasound Obstet Gynecol. 2012;40(1):47–54.
  8. Durand I, Deverriere G, Thill C, Lety AS, Parrod C, David N, et al. Prenatal detection of coarctation of the aorta in a non-selected population: a prospective analysis of 10 years of experience. Pediatr Cardiol. 2015;36(6):1248–54.
  9. Kailin JA, Santos AB, Yilmaz Furtun B, Sexson Tejtel SK, Lantin-Hermoso R. Isolated coarctation of the aorta in the fetus: A diagnostic challenge. Echocardiography. 2017;34(12):1768–75.
  10. Hunter LE, Pushparajah K, Miller O, Anderson D, Simpson JM. Prenatal diagnosis of left ventricular diverticulum and coarctation of the aorta. Ultrasound Obstet Gynecol. 2016;47(2):236–8.
  11. Slodki M, Rizzo G, Augustyniak A, Seligman NS, Zych-Krekora K, Respondek-Liberska M, et al. Retrospective cohort study of prenatally and postnatally diagnosed coarctation of the aorta (CoA): prenatal diagnosis improves neonatal outcome in severe CoA. J Matern Fetal Neonatal Med. 2020;33(6):947–51.
  12. E Gómez-Montes, I Herraiz, A Mendoza, D Escribano, A Galindo. Prediction of coarctation of the aorta in the second half of pregnancy. Ultrasound Obstet Gynecol. 2013; 41(3):298-305.
  13. Mărginean C, Mărginean CO, Muntean I, Togănel R, Voidăzan S, Gozar L. The role of ventricular disproportion, aortic, and ductal isthmus ultrasound measurements for the diagnosis of fetal aortic coarctation, in the third trimester of pregnancy. Med Ultrason. 2015;17(4):475–81.
  14. Anuwutnavin S, Satou G, Chang R-K, DeVore GR, Abuel A, Sklansky M. Prenatal sonographic predictors of neonatal coarctation of the aorta. J Ultrasound Med. 2016;35(11):2353–64.
  15. Buyens A, Gyselaers W, Coumans A, Al Nasiry S, Willekes C, Boshoff D, et al. Difficult prenatal diagnosis: fetal coarctation. Facts Views Vis ObGyn. 2012;4(4):230.

 

Iranian Journal of Neonatology
Volume 13, Issue 4
Autumn 2022
Pages 17-20