Invited Commentary:
Prenatal diagnosis of hypoplastic arch and coarctation of aorta improves
survival and reduces morbidity after birth. (1, 2) Significant
improvement in diagnosis of fetal congenital heart defect has been made
with advance in technology and experience including fetal ultrasound and
fetal echocardiography. However prenatal diagnosis of hypoplastic aortic
arch and coarctation of aorta is still challenging and remains one of
the most difficult cardiac defects to diagnose before birth with
relatively high false positive and false negative rate compared to other
major congenital heart defects. (3, 4)
The presence of hypoplasia of the isthmus and transverse arch is the
most consistent and the definitive antenatal sign of postnatal
coarctation. (4) In this study, Evans et al retrospectively reviewed a
large number of cases with prenatal diagnosis of hypoplastic aortic arch
and explored the challengers and complexities of the referral,
indication, risk factor, diagnosis and the accuracy of prediction for
the need of postnatal procedure. The results demonstrate the significant
improvement of prenatal diagnosis of hypoplastic aortic arch and
coarctation of aorta over the past five years. Since 2017 in their
state-wide fetal cardiology program in Nevada, the detection rate of
infants who need intervention of aortic arch for coarctation of aorta
and hypoplastic arch after birth, improved from 38% to 82%, p=.04.
The results also show the significant overlapping of the fetal aortic
isthmus z score between the infants who need the arch procedure and
those who do not. Of the 34 that had a postnatal procedure 11 (32%) had
a fetal aortic isthmus z-value with a median and range of -2.8 (-1 to
-5.0), and of 51 that did not undergo postnatal procedure 20 (38%) had
a z-value with a mean and range of -2.6 (-1.5 to -4.6). Of the 44
presumed ductus arteriosus dependent aortic arch obstruction by fetal
echocardiogram 10 had subsequently prostaglandin E 1 discontinued.
Their findings further demonstrate the anatomic and pathophysiological
complexity of ductus arteriosus and aortic isthmus region in patients
with coarctation of aorta and dynamic change following the transition
from fetal to neonatal circulation and the need to adopt multiparametric
diagnostic model and multicriteria prediction model. (5, 6, 7, 8) Many
investigators have been working to explore the application of 3D fetal
echocardiography and CMR in fetal aortic arch anomalies to increase the
accuracy of the diagnosis of coarctation of aorta and the prediction for
postnatal intervention. (9, 10, 11)
- Franklin O, Burch M, Manning N, Sleeman K, Gould S, Archer N. Prenatal
diagnosis of coarctation of the aorta improves survival and reduces
morbidity. Heart. 2002; 87 (1):67–9.
- Słodki M, Rizzo G, Augustyniak A, Seligman NS, Zych-Krekora K,
Respondek-Liberska M; International Prenatal Cardiology Collaboration
Group. Retrospective cohort study of prenatally and postnatally
diagnosed coarctation of the aorta (CoA): prenatal diagnosis improve
neonatal outcome in severe CoA. J Matern Fetal Neonatal Med.
2020;33(6):947–951.
- Tegnander E, Williams W, Johansen OJ, Blaas HG, Eik-Nes SH. Prenatal
detection of heart defects in a non-selected population of 30,149
fetuses–detection rates and outcome. Ultrasound Obstet Gynecol. 2006;
27:252–265.
- Hornberger LK, Sahn DJ, Kleinman CS, Copel J, Silverman NH. Antenatal
diagnosis of coarctation of the aorta: a multicenter experience. J Am
Coll Cardiol. 1994; 23:417–423.
- Enery
Gómez-Montes , Ignacio
Herraiz
García , David
Escribano Abad , Jesús Rodríguez
Calvo , Cecilia
Villalaín
González , Alberto
Galindo
Izquierdo 1Application of a Global Multiparameter Scoring System for the Prenatal
Prediction of Coarctation of the Aorta. Journal clinical medicine. J
Clin Med. 2021; 20;10 (16):3690.
- Meaghan
Beattie, Shabnam Peyvandi , Suguna
Ganesan , Anita
Moon-Grady Toward Improving the Fetal Diagnosis of
Coarctation of the Aorta. Pediatr Cardiol. 2017; 38 (2):344-352.
- Wang H, Lei W, Liu J, Yang B, Li H, Huang D
The Diastolic and
Systolic Velocity-Time Integral Ratio of the Aortic Isthmus Is a
Sensitive Indicator of Aortic Coarctation in Fetuses. J Am Soc
Echocardiogr. 2019; 32(11):1470-1476.
- DeVore GR, Haxel C, Satou G, Sklansky M, Pelka MJ, Jone PN, Cuneo BF.
Improved detection of
coarctation of the aorta using speckle-tracking analysis of fetal
heart on last examination prior to delivery. Ultrasound Obstet
Gynecol. 2021; 57(2):282-291
- Zhuo Chen MD, PhD,
Yue
Zhou
MS,Jingying
Wang
PhD,Xiaowei
Liu MD, PhD,
Shuping
Ge
MD,Yihua
He MD, PhD Modeling of coarctation of aorta in human fetuses using
3D/4D fetal echocardiography and computational fluid dynamics
Echocardiography. 2017; 34(12):1858-1866
- David
F A Lloyd, MPhil, Kuberan Pushparajah,
MD, John
M Simpson, Prof,
MD, Joshua
F P van Amerom, BASc, Milou P M van Poppel,
MD, Alexander
Schulz, Bernard
Kainz,
PhD,Maria
Deprez,
PhD,Maelene
Lohezic,
PhD, Joanna
Allsop, Sujeev Mathur,
MD, Hannah
Bellsham-Revell,
MD, Trisha
Vigneswaran,
MRCPCH, Marietta
Charakida,
PhD, Owen
Miller,
MD, Vita
Zidere, MD, Gurleen Sharland, Prof,
MD, Mary
Rutherford, Prof,
MD, Joseph
V Hajnal, Prof,
PhD, and Reza
Razavi, Prof, MD Three-dimensional visualization of the fetal heart
using prenatal MRI with motion-corrected slice-volume registration: a
prospective, single-centre cohort study
Lancet. 2019;
20393(10181): 1619–1627.
- David
F.A. Lloyd, Milou P.M. van Poppel,
Kuberan
Pushparajah,
Trisha
V. Vigneswaran,
Vita
Zidere,
Johannes
Steinweg,
Joshua
F.P. van Amerom,
Thomas
A. Roberts,
Alexander
Schulz,
Marietta
Charakida,
Owen
Miller,
Gurleen
Sharland,
Mary
Rutherford,
Joseph
V. Hajnal,
John
M. Simpson,
Reza
Razavi. Analysis of 3-Dimensional Arch Anatomy, Vascular Flow, and
Postnatal Outcome in Cases of Suspected Coarctation of the Aorta Using
Fetal Cardiac Magnetic Resonance Imaging. Circulation: Cardiovascular
Imaging. 2021; 14 ( 7): 2021; P e012411