Sonographic predictors of surgery in fetal coarctation of the aorta
Article first published online: 15 JUN 2012
Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Ultrasound in Obstetrics & Gynecology
Volume 40, Issue 1, pages 47–54, July 2012
How to Cite
Jowett, V., Aparicio, P., Santhakumaran, S., Seale, A., Jicinska, H. and Gardiner, H. M. (2012), Sonographic predictors of surgery in fetal coarctation of the aorta. Ultrasound Obstet Gynecol, 40: 47–54. doi: 10.1002/uog.11161
- Issue published online: 29 JUN 2012
- Article first published online: 15 JUN 2012
- Accepted manuscript online: 28 MAR 2012 06:11AM EST
- Manuscript Accepted: 13 MAR 2012
- aortic coarctation;
- coarctation shelf;
Isolated fetal coarctation of the aorta (CoA) has high false-positive diagnostic rates by cardiologists in tertiary centers. Isthmal diameter Z-scores (I), ratio of isthmus to duct diameters (I:D), and visualization of CoA shelf (Shelf) and isthmal flow disturbance (Flow) distinguish hypoplastic from normal aortic arches in retrospective studies, but their ability to predict a need for perinatal surgery is unknown. The aim of this study was to determine whether these four sonographic features could differentiate prenatally cases which would require neonatal surgery in a prospective cohort diagnosed with CoA by a cardiologist.
From 83 referrals with cardiac disproportion (January 2006 to August 2010), we identified 37 consecutive fetuses diagnosed with CoA. Measurements of I and I:D were made and the presence of Shelf or Flow recorded. Sensitivity, specificity and areas under receiver–operating characteristics curves, using previously reported limits of I < − 2 and I:D < 0.74, as well as Shelf and Flow were compared at first and final scan. Associations between surgery and predictors were compared using multivariable logistic regression and changes in measurements using ANCOVA.
Among the 37 fetuses, 30 (81.1%) required surgery and two with an initial diagnosis of CoA were revised to normal following isthmal growth, giving an 86% diagnostic accuracy at term. The median age at first scan was 22.4 (range. 16.6–7.0) weeks and the median number of scans per fetus was three (range, one to five). I < − 2 at final scan was the most powerful predictor (odds ratio, 3.6 (95% CI, 0.47–27.3)). Shelf was identified in 66% and Flow in 50% of fetuses with CoA.
Incorporation of these four sonographic parameters in the assessment of fetuses with suspected CoA at a tertiary center resulted in better diagnostic precision regarding which cases would require neonatal surgery than has been reported previously. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.