Fetal Echocardiographic Findings to Predict Early Surgical Repair and Neonatal Outcomes in Fetuses with Isolated Coarctation of the Aorta

Abstract

Objective The aim of this study was to investigate fetal echocardiographic findings in predicting the need for surgical repair in fetuses with coarctation of the aorta (CoA) and to evaluate perinatal outcomes.

Study Design In this retrospective study, fetuses diagnosed with CoA in a tertiary center between January 2015 and June 2021 were analyzed. Fetal echocardiographic measurements and quantitative findings, middle cerebral artery (MCA) and umbilical artery (UA) Doppler indices, and perinatal outcomes were recorded.

Results A total of 57 fetuses with CoA were included in the study. In total, 51 (89.5%) pregnancies resulted in live births and 32 (62.8%) of the neonates underwent surgical repair. The left ventricle/right ventricle width ratio and aortic isthmus z-score were significantly lower in fetuses who underwent surgical repair (p = 0.004 0.001, respectively). Retrograde flow in the aortic isthmus (odds ratio [OR]:7.43; 95% confidence interval [CI]: 1.98–27.76), left-to-right foramen ovale shunt (OR: 8.50; 95% CI: 1.68–42.98), and ventricular septal defect (OR: 9.63; 95% CI: 1.90–48.74) were associated with the need for surgical repair. A new scoring system integrating these echocardiographic findings had 89% specificity and 54% sensitivity in predicting surgical repair. Fetal growth restriction rates, preterm birth rates, mean MCA pulsatility index (PI), and mean UA PI were similar in fetuses with and without surgical repair.

Conclusion A scoring system integrating echocardiographic findings in fetuses with CoA may improve the prediction of surgical repair need. There is no evidence of an increased risk of FGR, preterm birth, and brain sparing effect in fetuses with CoA who require surgical repair.

Key Points

• Coarctation of the aorta is one of the most difficult congenital heart defects to diagnose.

• A new scoring system may improve the prediction of surgical repair need.

• There is no increased risk of fetal growth restriction in fetuses requiring early surgical repair.

Keywords

aortic isthmus - coarctation of the aorta - fetal echocardiography - neonatal outcomes - prenatal diagnosis

Ethical Approval

Approval was granted by the Ethics Committee of University of Health Sciences Zeynep Kamil Training and Research Hospital (date: June 16, 2021/no.: 121).

Authors' Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by M.A., O.D., İ.K.Y., and N.E. The first draft of the manuscript was written by M.A. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Publication History

Received: 04 June 2022

Accepted: 12 July 2022

Accepted Manuscript online:
20 July 2022

Article published online:
12 September 2022

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