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

Our results show that reduced blood flow though the left heart is associated with important configurational changes at the aortic isthmus in fetal life, which in turn appear to relate closely to the development of critical coarctation of the aorta after birth

David F.A. Lloyd

2021

Scholarcy highlights

  • Identifying fetuses at risk of severe neonatal coarctation of the aorta can be lifesaving but is notoriously challenging in clinical practice with a high rate of false positives
  • Reduced blood flow in the fetal ascending aorta and at the aortic isthmus was associated with increasing angulation and proximal displacement of the isthmus and was seen in both true positive and false positive cases
  • 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
  • Reduced flow through the left heart was seen in both the true positive and false positive cases when compared with healthy controls and was associated with significant changes in the angulation of the proximal displacement of the aortic isthmus in both groups
  • A multivariate logistic regression model incorporating ascending aortic blood flow and proximal displacement of the aortic isthmus was highly predictive of the need for postnatal intervention, correctly classifying 95% of the true positive and 91% of false positive cases
  • A model incorporating ascending aorta flow and proximal displacement of the aortic isthmus using novel magnetic resonance imaging methods in the third trimester is highly predictive of critical neonatal coarctation
  • While there did seem to be a relationship between coarctation of the aorta and an increased distance between the left common carotid and subclavian artery, we found this to be poorly specific, in keeping with postnatal echocardiographic studies. We included the relationship between the angle between the ascending aorta and the descending aorta and the angle between the transverse arch and the DAo, both of which have been reported to have high sensitivity in a single retrospective study of 40 subjects by fetal echocardiography. Neither measure was found to have a significant association with postnatal coarctation in our study

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