Prenatal Sonographic Predictors of Neonatal Coarctation of the Aorta

• Published in: Journal of ultrasound in medicine 2016-11, Vol.35 (11), p.2353-2364
• Main Authors: Anuwutnavin, Sanitra, Satou, Gary, Chang, Ruey-Kang, DeVore, Greggory R., Abuel, Ashley, Sklansky, Mark
• Format: Article
• Language: English
• Subjects: Aorta - diagnostic imaging; Aorta - embryology; Aortic Coarctation - diagnostic imaging; Aortic Coarctation - embryology; coarctation of the aorta; Echocardiography - methods; Female; fetal echocardiography; Humans; Infant, Newborn; prediction; Predictive Value of Tests; Pregnancy; prenatal diagnosis; Reproducibility of Results; Sensitivity and Specificity; sonographic indicators; Ultrasonography, Prenatal - methods
• ISSN: 0278-4297; 1550-9613
• DOI: 10.7863/ultra.15.06049

Objectives To identify practical prenatal sonographic markers for the postnatal diagnosis of coarctation of the aorta. Methods We reviewed the fetal echocardiograms and postnatal outcomes of fetal cases of suspected coarctation of the aorta seen at a single institution between 2010 and 2014. True‐ and false‐positive cases were compared. Logistic regression analysis was used to determine echocardiographic predictors of coarctation of the aorta. Optimal cutoffs for these markers and a multivariable threshold scoring system were derived to discriminate fetuses with coarctation of the aorta from those without coarctation of the aorta. Results Among 35 patients with prenatal suspicion of coarctation of the aorta, the diagnosis was confirmed postnatally in 9 neonates (25.7% true‐positive rate). Significant predictors identified from multivariate analysis were as follows: Z score for the ascending aorta diameter of −2 or less (P = < .001), Z score for the mitral valve annulus of −2 or less (P= .033), Zscore for the transverse aortic arch diameter of −2 or less (P= .028), and abnormal aortic valve morphologic features (P= .026). Among all variables studied, the ascending aortic Z score had the highest sensitivity (78%) and specificity (92%) for detection of coarctation of the aorta. A multivariable threshold scoring system identified fetuses with coarctation of the aorta with still greater sensitivity (89%) and only mildly decreased specificity (88%). Conclusions The finding of a diminutive ascending aorta represents a powerful and practical prenatal predictor of neonatal coarctation of the aorta. A multivariable scoring system, including dimensions of the ascending and transverse aortas, mitral valve annulus, and morphologic features of the aortic valve, provides excellent sensitivity and specificity. The use of these practical sonographic markers may improve prenatal detection of coarctation of the aorta.