Timing of Presentation and Postnatal Outcome of Infants Suspected of Having Coarctation of the Aorta During Fetal Life

AbstractThe morphology of the aortic valve was studied in 1,022 heart specimens belonging to the collection of the Institute of Pathological Anatomy, University of Padua. Twenty specimens were found to have a unicommissural aortic valve, characterized by the presence of a single leaflet with only one functional commissure; however, the presence of two raphes enabled the recognition of a basically three-sinus arrangement. Age and gender were known in 19 cases: 14 male and five female, mean age nine days. In 19 cases, the unicommissural valve was dysplastic and resulted in a severe congenital aortic valvar stenosis. Only in two hearts was the unicommissural nature of the aortic valve an isolated finding; among the remaining 18, left ventricular fibroelastosis in 11, malformation of the mitral valve in 11, hypoplasia of the left ventricle in eight, ventricular septal defect in four, mitral atresia in three, and subaortic fibrous diaphragm in one. Furthermore, seven (35%) of these 20 unicommissural aortic valves were associated with coarctation of the aorta. Statistical analysis shows that this association is not a random event. Our findings support the hypothesis that the unicommissural aortic valve originates from the early fusion of the three mesenchymal valvar cushions or leaflet primordia. Although the present data do not exclude the possibility that reduction of the blood flow through the aorta during fetal life may play a role in the formation of the unicommissural aortic valve, they rather point in the direction that another etiologic factor, such as an anomalous migration of neural crest cells, may be responsible for the fusion of the valvar cushions.

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Outcome and Impact of Associated Left-Sided Cardiac Lesions in Coarctation of the Aorta Diagnosed During Fetal Life

The American Journal of Cardiology ◽

10.1016/j.amjcard.2021.11.023 ◽

2021 ◽

Author(s):

Stavros Polyviou ◽

Marietta Charakida ◽

Owen I. Miller ◽

Thomas Witter RSCN ◽

Trisha V. Vigneswaran ◽

...

Keyword(s):

Coarctation Of The Aorta ◽

Fetal Life ◽

Cardiac Lesions

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P18.01: New explanation of false-positive diagnosis of coarctation of the aorta during fetal life

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.19758 ◽

2018 ◽

Vol 52 ◽

pp. 184-184

Author(s):

M. Slodki ◽

K. Taranenko ◽

K. Zych-Krekora ◽

M. Respondek-Liberska

Keyword(s):

False Positive ◽

Coarctation Of The Aorta ◽

Fetal Life ◽

Positive Diagnosis ◽

False Positive Diagnosis

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Coarctation of the aorta: From fetal life to adulthood

Cardiology Journal ◽

10.5603/cj.2011.0003 ◽

2011 ◽

Vol 19 (5) ◽

pp. 487-495 ◽

Cited By ~ 86

Author(s):

Damien Kenny ◽

Ziyad M. Hijazi

Keyword(s):

Coarctation Of The Aorta ◽

Fetal Life

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COARCTATION OF THE AORTA AS A CAUSE OF DEATH IN EARLY INFANCY

PEDIATRICS ◽

10.1542/peds.8.2.192 ◽

1951 ◽

Vol 8 (2) ◽

pp. 192-203

Author(s):

ROBERT C. BAHN ◽

JESSE E. EDWARDS ◽

JAMES W. DUSHANE

Keyword(s):

Cause Of Death ◽

Aortic Coarctation ◽

Ductus Arteriosus ◽

Coarctation Of The Aorta ◽

Left Ventricular ◽

Early Infancy ◽

Fetal Life ◽

Descending Aorta ◽

Congestive Failure

This is a report of three cases in each of which an infant exhibited coarctation of the aorta at the level of a closed or closing ductus arteriosus. In all cases the collateral channels were poorly developed. It appears from the available evidence that death resulted from left ventricular congestive failure secondary to an obstructive hypertension. The development of collaterals to by-pass a coarctation of the aorta seems to depend upon the relation of the aortic coarctation to the aortic mouth of the ductus arteriosus. When the coarctation lies distal to the ductus, collaterals develop. When the coarctation lies proximal to the ductus, adequate collaterals do not develop before birth. When the coarctation lies opposite the aortic mouth of the ductus arteriosus, the development of collaterals during fetal life seems to depend upon the direction that the blood flowing in the ductus arteriosus takes. When the flow is into the aorta proximal to the coarctation, collaterals would be expected to develop; while when the ductal flow is into the descending aorta, adequate collaterals would not be expected to develop in the fetus. The three cases reported fall into the latter category.

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P4646Prospective study for antenatal diagnosis of coarctation of the aorta

European Heart Journal ◽

10.1093/eurheartj/ehz745.1028 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Meysonnier Marechal ◽

S Di Filippo ◽

N Pangaud ◽

C Galoin Bertail ◽

H Joly ◽

...

Keyword(s):

Ductus Arteriosus ◽

Coarctation Of The Aorta ◽

Roc Curves ◽

Mitral Annulus ◽

Aortic Annulus ◽

Fetal Life ◽

Aortic Isthmus ◽

Single Center Study ◽

Great Vessels ◽

Z Scores

Abstract The objective of this study was to define echocardiographic (ECHO) parameters during fetal life, to predict postnatal aortic coarctation (COA). Material and methods This prospective single-center study from 2010 to 2018 included all fetus diagnosed with isolated ventricular and/ or great vessels asymetry (right heart dominance). Complex CHD were excluded. The cohort was divided in patients with coarctation after birth (COA) and those free from coarctation (noCOA). Left heart, aortic and ductus measurements were collected serially at second trimester (T2), third trimester (T3) ad Z-scores were assessed. COA and noCOA were compared, sensitivity (Se) and specificity (Spec) and ROC curves (cut-off values) were assessed for each parameter. Results 67 cases were included: 34 (50.7%) ranged in group COA and 33 (49.3%) in noCOA. Coarctation occurred more frequently if suspected at T2 (70.6% in COA vs 30.3% in noCOA, p=0.001). Mitral annulus (T3) was 8.6mm in COA vs 10.3mm in noCOA (p=0.002) with cut-off <7.3mm (Se= 50%, Spec= 93.6%, OR= 14.5). Aortic annulus diameter (T3) was 4.8mm in COA vs 6mm in noCOA (p=0.005), with cut-off <5.4mm (Se= 65%, Spec= 77%, OR= 6.3). Aortic isthmus diameter (T3) was 1.4mm in COA vs 2.8mm in noCOA (p=0.003), with cut-off <3mm (Se= 91%, Spec= 65%, OR= 18.9). Ductus arteriosus/ aortic isthmus ratio (T3) was 2.5 in COA vs 1.8 in noCOA (p=0.01) with cut-off >1.57mm (Se= 90.5%, Spec= 62%, OR= 15.4). Conclusion Mitral annulus <7.3mm, aortic annulus <5.4mm, aortic isthmus <3mm and ductus/isthmus ratio >1.57 assessed during 3rd trimester of fetal life may help to predict postnatal coractation of the aorta. These results have to be confirmed by larger prospective studies.

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OP01.05: Sonographic prenatal features of postnatal outcome in coarctation of the aorta

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.13641 ◽

2014 ◽

Vol 44 (S1) ◽

pp. 63-63

Author(s):

A. Ruiz ◽

C. Rodo ◽

S. Arevalo ◽

G. Giralt ◽

E. Llurba ◽

...

Keyword(s):

Coarctation Of The Aorta ◽

Postnatal Outcome

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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 ◽

10.1161/circimaging.121.012411 ◽

2021 ◽

Author(s):

David F.A. Lloyd ◽

Milou P.M. van Poppel ◽

Kuberan Pushparajah ◽

Trisha V. Vigneswaran ◽

Vita Zidere ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Blood Flow ◽

Phase Contrast ◽

Fetal Mri ◽

Coarctation Of The Aorta ◽

Resonance Imaging ◽

3 Dimensional ◽

Aortic Isthmus ◽

Vascular Flow ◽

Postnatal Outcome

Background: Identifying fetuses at risk of severe neonatal coarctation of the aorta (CoA) can be lifesaving but is notoriously challenging in clinical practice with a high rate of false positives. Novel fetal 3-dimensional and phase-contrast magnetic resonance imaging (MRI) offers an unprecedented means of assessing the human fetal cardiovascular system before birth. We performed detailed MRI assessment of fetal vascular morphology and flows in a cohort of fetuses with suspected CoA, correlated with the need for postnatal intervention. Methods: Women carrying a fetus with suspected CoA on echocardiography were referred for MRI assessment between 26 and 36 weeks of gestation, including high-resolution motion-corrected 3-dimensional volumes of the fetal heart and phase-contrast flow sequences gated with metric optimized gating. The relationship between aortic geometry and vascular flows was then analyzed and compared with postnatal outcome. Results: Seventy-two patients (51 with suspected fetal CoA and 21 healthy controls) underwent fetal MRI with motion-corrected 3-dimensional vascular reconstructions. Vascular flow measurements from phase-contrast sequences were available in 53 patients. In the CoA group, 25 of 51 (49%) required surgical repair of coarctation after birth; the remaining 26 of 51 (51%) were discharged without neonatal intervention. Reduced blood flow in the fetal ascending aorta and at the aortic isthmus was associated with increasing angulation ( P =0.005) and proximal displacement ( P =0.006) of the isthmus and was seen in both true positive and false positive cases. A multivariate logistic regression model including aortic flow and isthmal displacement explained 78% of the variation in outcome and correctly predicted the need for intervention in 93% of cases. Conclusions: Reduced blood flow though the left heart is associated with important configurational changes at the aortic isthmus in fetal life, predisposing to CoA when the arterial duct closes after birth. Novel fetal MRI techniques may have a role in both understanding and accurately predicting severe neonatal CoA.

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