Prenatal diagnosis of coarctation: Impact on early and late cardiovascular outcome

• Published in: International journal of cardiology 2024-02, Vol.396, p.131430-131430, Article 131430
• Main Authors: Fogaça da Mata, Miguel, Anjos, Rui, Lemos, Mariana, Nelumba, Tchitchamene, Cordeiro, Susana, Rato, João, Teixeira, Ana, Abecasis, Miguel
• Format: Article
• Language: English
• Subjects: Aortic Coarctation; Aortic Coarctation - diagnostic imaging; Aortic Coarctation - epidemiology; Aortic Coarctation - surgery; Cardiovascular outcomes; Cardiovascular System; Female; Follow-Up Studies; Humans; Hypertension - epidemiology; Infant, Newborn; Long-term follow-up; Pregnancy; Prenatal Diagnosis; Prevalence
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2023.131430

Prenatal diagnosis (PND) of aortic coarctation (AoCo) has been associated with a significant improvement in early results, but there is limited information on the long-term cardiovascular outcome. We studied 103 patients with simple AoCo, operated in the neonatal period, with a median follow-up of 8,5 years (2 to 23,7 years), with 47% followed for over 10 years. PND was made in 35%. The primary aim was to determine the short and long-term cardiovascular impact of PND of AoCo. Neonates with PND had less preoperative neonatal complications, with only 2,8% incidence of a composite preoperative severe morbidity course, compared to 28% in the postnatal group. PND patients underwent surgery 8 days earlier and had a shorter length of stay in ICU. PND did not impact the incidence of post-operative complications. On the long-term, prevalence of hypertension, left ventricular hypertrophy and rate of recoarctation were not influenced by PND. The PND group had mean 24 h diastolic BP 9 mmHg lower and mean daytime diastolic BP 11 mmHg lower. In the final multivariable model, PND was the single independent variable correlating with daytime diastolic BP. PND of AoCo effectively leads to a better pre-operative course with less pre-operative morbidity. We found no significant differences in immediate post-operative cardiovascular outcomes. A better initial course of patients with PND does not have a major long-term impact on cardiovascular outcomes, nevertheless, at late follow-up PND patients had lower diastolic BP values on ambulatory monitoring, which may have an impact on long-term cardiovascular risk. •Prenatal diagnosis of aortic coarctation leads to better pre-operative course•Prenatal diagnosis of aortic coarctation doesn't impact operative morbi-mortality.•Long-term mean diastolic BP is improved by prenatal diagnosis of aortic coarctation.•Adverse long-term outcomes are not influenced by prenatal diagnosis of coarctation.•Prenatal diagnosis of aortic coarctation may improve long-term cardiovascular risk.