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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.
Summary
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.
