Prenatal Detection of Coarctation of the Aorta in a Non-selected Population: A Prospective Analysis of 10 Years of Experience

The objective of this study was to assess the ability of different parameters to identify fetuses requiring neonatal care for coarctation of the aorta (CoA). Between January 2003 and December 2012, 175 fetuses referred for great vessel disproportion were divided into two groups: group A ( n = 51) w...

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Bibliographic Details
Published in:	Pediatric cardiology Vol. 36; no. 6; pp. 1248 - 1254
Main Authors:	Durand, I., Deverriere, G., Thill, C., Lety, A. S., Parrod, C., David, N., Barre, E., Hazelzet, T.
Format:	Journal Article
Language:	English
Published:	New York Springer US 01-08-2015 Springer
Subjects:	Analysis Aorta - abnormalities Aorta - diagnostic imaging Aorta, Thoracic - abnormalities Aorta, Thoracic - diagnostic imaging Aortic coarctation Aortic Coarctation - diagnosis Aortic Coarctation - diagnostic imaging Aortic Coarctation - epidemiology Aortic Valve - abnormalities Aortic Valve - diagnostic imaging Cardiac Surgery Cardiology Echocardiography - instrumentation Echocardiography - methods Female Fetus - abnormalities Gestational Age Heart Septal Defects, Ventricular - diagnosis Heart Septal Defects, Ventricular - diagnostic imaging Heart Septal Defects, Ventricular - epidemiology Humans Medicine Medicine & Public Health Original Article Predictive Value of Tests Pregnancy Pregnant women Prenatal Diagnosis - instrumentation Prenatal Diagnosis - methods Prospective Studies Risk Factors Ultrasonography, Prenatal - instrumentation Ultrasonography, Prenatal - methods Vascular Surgery France Fetal echocardiography Detection rate Prenatal diagnosis Vascular disproportion Coarctation of the aorta
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Summary:	The objective of this study was to assess the ability of different parameters to identify fetuses requiring neonatal care for coarctation of the aorta (CoA). Between January 2003 and December 2012, 175 fetuses referred for great vessel disproportion were divided into two groups: group A ( n = 51) with high risk of CoA and delivery planned in tertiary care referral center and group B ( n = 124) with no increased risk of CoA. In group A, diagnosis of CoA was confirmed in 38/51 (74 %). In group B, 2/124 had CoA. Multiple logistic regression analysis identified the best combination as diffusely hypoplastic and/or angular aortic arches, ventricular septal defect and aortic valve diameter <5 mm at 36-week gestational age (GA). Positive predictive value was 75 % when vessel disproportion was noted before 28-week GA and 73 % in the third trimester. Postnatal diagnosis involved 38 cases of CoA which had not been referred. One case of CoA diagnosed after birth was referred prenatally for difficulty of screening without any defect. The results of our prospective study are in agreement with those of previous series, but our false positive rate was lower especially when the diagnosis of vascular disproportion was made at third trimester. The performance of fetal cardiac screening does not seem to be very good, but prenatal diagnosis is probably not always possible: Among our three false negative cases, two had isolated vascular disproportion and the third no risk factors.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0172-0643 1432-1971
DOI:	10.1007/s00246-015-1153-1