Improving Prenatal Diagnosis of Coarctation of the Aorta

Conall T. Morgan, Brigitte Mueller, Varsha Thakur, Vitor Guerra, Callaghan Jull, Luc Mertens, Mark Friedberg, Fraser Golding, Mike Seed, Steven E.S. Miner, Edgar T. Jaeggi, Cedric Manlhiot, Lynne E. Nield

Research output: Contribution to journalArticle

Abstract

Background: The purpose of the study was to evaluate the association between fetal echocardiographic measurements and the need for intervention (primary coarctation repair, staged coarctation repair, or catheter intervention) in prenatally diagnosed coarctation of the aorta. Methods: A single-centre retrospective cohort study (2005-2015) of 107 fetuses diagnosed with suspected coarctation of the aorta in the setting of an apex-forming left ventricle and antegrade flow across the mitral and aortic valves. Results: Median gestational age at diagnosis was 32 weeks (interquartile range, 23-35 weeks). Fifty-six (52%) did not require any neonatal intervention, 51 patients (48%) underwent a biventricular repair. In univariable analysis, an increase in ascending aorta (AAo) peak Doppler flow velocity (odds ratio [OR], 1.40 [95% confidence interval [CI], 1.05-1.91] per 20 cm/s; P = 0.03) was associated with intervention. No intervention was associated with larger isthmus size (OR, 0.23; P < 0.001), transverse arch diameter (OR, 0.23; P < 0.001), and aortic (OR, 0.72; P = 0.02), mitral (OR, 0.58; P = 0.001), and AAo (OR, 0.53; P < 0.001) z-scores. In multivariable analysis, higher peak AAo Doppler (OR, 2.51 [95% CI, 1.54-4.58] per 20 cm/s; P = 0.001) and younger gestational age at diagnosis (OR, 0.81 [95% CI, 0.70-0.93] per week; P = 0.005) were associated with intervention, whereas a higher AAo z-score (OR, 0.65 [95% CI, 0.43-0.94] per z; P = 0.029) and transverse arch dimension (OR, 0.44 [95% CI, 0.18-0.97]; P = 0.05) decreased the risk of intervention. Conclusions: In prenatally suspected coarctation, the variables associated with intervention comprised smaller AAo and transverse arch size, earlier gestational age at diagnosis, and the additional finding of a higher peak AAo Doppler.

Original languageEnglish (US)
Pages (from-to)453-461
Number of pages9
JournalCanadian Journal of Cardiology
Volume35
Issue number4
DOIs
StatePublished - Apr 1 2019
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Morgan, C. T., Mueller, B., Thakur, V., Guerra, V., Jull, C., Mertens, L., Friedberg, M., Golding, F., Seed, M., Miner, S. E. S., Jaeggi, E. T., Manlhiot, C., & Nield, L. E. (2019). Improving Prenatal Diagnosis of Coarctation of the Aorta. Canadian Journal of Cardiology, 35(4), 453-461. https://doi.org/10.1016/j.cjca.2018.12.019