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Echocardiographic findings for improved prenatal diagnosis of aortic coarctation with ventricular septal defect

Yunyu Chen1, Huixian Li2, Danping Huang1

  • 1Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, 510623, China.

The International Journal of Cardiovascular Imaging
|December 21, 2021
PubMed

Insights

Accurate prenatal diagnosis of coarctation of the aorta (CoA) with ventricular septal defect (VSD) is improved using spectral Doppler metrics. Combining these with the aortic isthmus Z score enhances diagnostic accuracy and reduces false positives in fetal assessments.

Area of Science:

  • Fetal Cardiology
  • Diagnostic Imaging
  • Congenital Heart Defects

Background:

  • Prenatal diagnosis of coarctation of the aorta (CoA) associated with ventricular septal defect (VSD) presents significant challenges.
  • Accurate identification of these fetal cardiac anomalies is crucial for timely intervention and improved outcomes.
  • Existing sonographic methods require refinement for enhanced predictive capability.

Purpose of the Study:

  • To identify sonographic findings, particularly Doppler-derived metrics, that are most effective in predicting fetal CoA associated with VSD.
  • To evaluate the diagnostic performance of quantitative spectral Doppler measurements in conjunction with conventional imaging parameters.
  • To improve the accuracy of prenatal diagnosis for CoA/VSD, thereby reducing false positive rates.

Main Methods:

  • Retrospective cohort study of 35 fetuses with suspected CoA/VSD.
  • Analysis of prenatal imaging characteristics including right/left ventricular ratio, pulmonary artery/aorta ratio, aortic isthmus (AOI) Z score, and diastolic (VTID) and systolic (VTIS) velocity-time integrals at the AOI.
  • Statistical evaluation using receiver operating characteristic curves (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI).

Main Results:

  • Significant differences were observed in PA/AO ratio, VTID, VTID/VTIS, and AOI Z score between true CoA and false positive groups.
  • The VTID/VTIS and VTID/(VTID + VTIS) metrics demonstrated high diagnostic performance (AUC 0.97) for CoA when associated with VSD.
  • Combining the VTID/VTIS metric with the AOI Z score significantly improved diagnostic accuracy (IDI 50%, NRI 82%), enhancing specificity without compromising sensitivity.

Conclusions:

  • Quantitative spectral Doppler metrics, specifically VTID/VTIS and VTID/(VTID + VTIS), are valuable tools for accurate prenatal detection of fetal CoA associated with VSD.
  • The integration of these spectral Doppler findings with the conventional AOI Z score offers a more robust approach to diagnosing CoA/VSD.
  • This combined approach aids in accurate fetal CoA detection, leading to a reduction in false positives and improved diagnostic precision.

Keywords:
Aortic coarctationFetal echocardiographyPrenatal diagnosisVentricular septal defect

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