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Arch watch: current approaches and opportunities for improvement
Alyssa R Thomas1,2, Philip T Levy3,4, Francesca Sperotto4,5
1Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA. Alyssa.Thomas@childrens.harvard.edu.
Insights
Coarctation of the aorta (CoA) is a critical heart defect often missed in newborns. New monitoring tools may improve early detection of CoA during ductus arteriosus closure, preventing collapse.
Area of Science:
- Cardiology
- Neonatal Medicine
- Congenital Heart Disease
Background:
- Coarctation of the aorta (CoA) is a ductus arteriosus (DA)-dependent congenital heart disease (CHD) causing aortic narrowing.
- CoA is difficult to diagnose prenatally and frequently missed by newborn screening, leading to severe outcomes.
- Current hemodynamic monitoring during DA closure lacks sensitivity for detecting evolving arch obstruction.
Purpose of the Study:
- To explore the benefits and limitations of existing and novel monitoring tools for hemodynamic compromise in newborns with CoA.
- To improve the sensitivity and specificity of detecting evolving arch obstruction during DA closure.
Main Methods:
- Review of existing hemodynamic monitoring practices during DA closure.
- Evaluation of novel tissue oxygenation and oxygen deprivation measures.
- Analysis of physiological changes in the aorta during DA closure in at-risk infants.
Main Results:
- Existing monitoring tools for arch obstruction during DA closure are often insensitive.
- Novel measures of tissue oxygenation show potential for improved sensitivity and specificity.
- Early detection of hemodynamic compromise in CoA remains a significant challenge.
Conclusions:
- Improved monitoring is crucial for timely diagnosis and management of critical CoA.
- Novel physiological monitoring tools may enhance the detection of hemodynamic compromise in at-risk neonates.
- Further research is needed to validate new tools for CoA monitoring during DA closure.
Abstract:
Coarctation of the aorta (CoA) is a ductus arteriosus (DA)-dependent form of congenital heart disease (CHD) characterized by narrowing in the region of the aortic isthmus. CoA is a challenging diagnosis to make prenatally and is the critical cardiac lesion most likely to go undetected on the pulse oximetry-based newborn critical CHD screen. When undetected CoA causes obstruction to blood flow, life-threatening cardiovascular collapse may result, with a high burden of morbidity and mortality. Hemodynamic monitoring practices during DA closure (known as an "arch watch") vary across institutions and existing tools are often insensitive to developing arch obstruction. Novel measures of tissue oxygenation and oxygen deprivation may improve sensitivity and specificity for identifying evolving hemodynamic compromise in the newborn with CoA. We explore the benefits and limitations of existing and new tools to monitor the physiological changes of the aorta as the DA closes in infants at risk of CoA.
