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Coarctation of the aorta (CoAo) is difficult to diagnose prenatally. Recent studies have focused on transverse arch, isthmus, and isthmus/ductal size as potential predictors of postnatal CoAo. Accurate diagnosis is important for appropriate delivery plans. We sought to determine additional prenatal echocardiographic predictors of postnatal CoAo requiring intervention.
We studied consecutive fetuses followed prenatally at a regional referral center for concerns of CoAo based on right/left heart size discrepancy from 8/06 to 6/12. Fetuses with additional major heart defects were excluded. Maternal and infant demographics, fetal echos, and post-natal outcomes were examined. The primary outcome was intervention for CoAo prior to hospital discharge after birth. The association of prenatal predictors was examined with univariate logistic regression analysis.
The study group included 58 fetuses, with 110 fetal echos. 47% of infants had CoAo and underwent surgical repair. On the first fetal echo, smaller mitral valve Z score (OR 0.56, P=0.01), smaller aortic valve Z score (OR 0.40, P=0.001), smaller ascending aorta Z score (OR 0.60, P=0.043), larger pulmonary to aortic valve ratio (OR 23.89, P=0.005), and smaller isthmus to ductal ratio (OR <0.01, P=0.009) were associated with postnatal CoAo intervention. On the final echo prior to delivery, only aortic valve Z score (OR 0.38, P=0.003), ascending aorta Z score (OR 0.46, P=0.005), and pulmonary to aortic valve ratio (OR 16.19, P=0.03) were associated with CoAo. Discrepancy in mitral and tricuspid valve size, transverse arch Z score, and right/left ventricular size were not predictive.
Aortic measurements are strongly associated with the need for CoAo repair, but no single fetal echocardiographic index is accurately predictive. Pulmonary to aortic valve ratio, which is easily determined on fetal echo, may increase clinical accuracy in predicting CoAo prenatally if used in a combined algorithm of echo parameters.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Cardiology Solutions: Aortic Disease
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1246-115
- 2013 American College of Cardiology Foundation