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Antenatal diagnosis of coarctation of the aorta: a multicenter experience
L K Hornberger1, D J Sahn, C S Kleinman
1Division of Pediatric Cardiology, University of California, San Diego School of Medicine.
Insights
Prenatal echocardiography can predict coarctation of the aorta by identifying aortic arch hypoplasia. This quantitative measurement, particularly of the isthmus and transverse arch, is a definitive antenatal sign for postnatal coarctation.
Area of Science:
- Fetal Cardiology
- Prenatal Diagnosis
- Congenital Heart Disease
Background:
- Previous studies suggested abnormal in utero aortic arch growth as a marker for coarctation.
- Identifying reliable prenatal markers for coarctation of the aorta is crucial for timely intervention.
Purpose of the Study:
- To evaluate echocardiographic observations for prenatal prediction of coarctation of the aorta.
- To identify specific fetal echocardiographic findings that aid in diagnosing coarctation.
Main Methods:
- Retrospective review of prenatal echocardiograms and postnatal outcomes in 20 infants with coarctation.
- Analysis of fetal aortic arch dimensions (transverse arch and isthmus) and blood flow patterns.
- Inclusion of cases with associated cardiac and chromosomal abnormalities.
Main Results:
- Aortic arch hypoplasia, specifically of the transverse arch and isthmus, was the most frequent finding.
- In most fetuses, the transverse arch and isthmus diameters were below the 3rd percentile for gestational age.
- Serial studies revealed progressive hypoplasia or flow reversal in some cases, indicating disease progression.
Conclusions:
- Quantitative hypoplasia of the aortic isthmus and transverse arch is the most consistent and definitive antenatal sign of postnatal coarctation.
- Serial echocardiographic studies are recommended for fetuses with associated anomalies to monitor the progression of distal arch hypoplasia.
Objectives:
The purpose of this study was to test observations that might aid prenatal prediction of the presence of coarctation of the aorta in newborn infants with and without other forms of heart disease.
Background:
Previous reports have suggested that abnormal growth of the aortic arch in utero may be identifiable as a marker for the diagnosis of coarctation.
Methods:
We reviewed the prenatal echocardiograms and postnatal outcome of 20 infants (gestational age at initial study 18 to 36 weeks) with coarctation of the aorta established postnatally, to identify echocardiographic findings that would most facilitate the prenatal diagnosis of coarctation. Associated cardiac lesions included double-inlet left ventricle anatomy (n = 5), double-outlet right ventricle (n = 4), abnormal aortic valve (n = 5), unbalanced atrioventricular canal (n = 3), and membranous ventricular septal defect (n = 1). Chromosomal abnormalities included XO karyotype (n = 1), trisomy 18 (n = 1), and trisomy 21 (n = 1).
Results:
Hypoplasia determined by measurement of the distal aortic arch was the most frequently observed finding among the fetuses with coarctation. In 12 of 15 fetuses with a well visualized transverse arch at initial prenatal study, the diameter of the transverse arch was < or = 3rd percentile for gestational age as compared with that in a normal group of fetuses. Ten of 10 fetuses with adequate images of the isthmus had isthmus hypoplasia at prenatal study with a diameter < or = 3rd percentile for gestational age. On serial study in six of seven, including three fetuses with normal distal arch measurements at initial study, the distal arch became progressively more hypoplastic for gestational age. In three there was no growth of the transverse arch or isthmus on serial study, and in three there was reversal of flow from antegrade to retrograde through the distal arch.
Conclusions:
In our study, quantitative hypoplasia of the isthmus and transverse arch was the most consistent observation and therefore the most definitive antenatal sign of postnatal coarctation. The potential for progression of distal arch hypoplasia necessitates serial study in fetuses with associated cardiac and noncardiac lesions.