Sustained maternal hyperoxygenation improves aortic arch dimensions in fetuses with coarctation

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Isolated coarctation of the aorta (CoA) (n=96). Intervention: Maternal hyperoxygenation vs. Room air. Primary outcome: Postnatal normal aortic arch (p=<0.01).

Shi Zeng; Jiawei Zhou; Qinghai Peng; Wen Deng; Ming Zhang; Yili Zhao; Tao Wang; Qichang Zhou

doi:10.1038/srep39304

December 16, 2016Scientific ReportsOpen Access

Sustained maternal hyperoxygenation improves aortic arch dimensions in fetuses with coarctation

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Key result

Sustained maternal hyperoxygenation significantly increased the rate of a normal aortic arch postnatally to 70.8% compared to 12.5% with room air in fetuses with isolated coarctation.

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Why the study?

Does sustained maternal hyperoxygenation improve left heart dimensions in fetuses with isolated coarctation of the aorta?

Study Design

Type

RCT (n=96)

Blinding

Open-label

Randomization

Randomized

Multicenter

No

Structured PICO

Does sustained maternal hyperoxygenation improve left heart dimensions in fetuses with isolated coarctation of the aorta?

P

Population

96 fetuses (48 normal and 48 with isolated coarctation of the aorta) at 18-40 weeks gestation, whose mothers were randomized to hyperoxygenation or room air and followed postnatally.

I

Intervention

Maternal hyperoxygenation (45% oxygen at 6 L/min via face mask, 3 hours per morning and afternoon, totally 6 h/d until delivery).

C

Comparator

Room air (for 24 CoA fetuses) and normal control fetuses (n=48).

O

Outcome

Time-course change of cardiac dimension Z-scores (mitral valve, tricuspid valve, aortic valve, ascending aorta, isthmus, pulmonary valve, main pulmonary artery, and descending aorta) measured by serial fetal echocardiography.surrogate

Main Result

Absolute Event Rate: 70.8% vs 12.5%

p-value: p=<0.01

Sustained maternal hyperoxygenation safely improves left heart dimensions in fetuses with isolated coarctation of the aorta, potentially offering a novel intrauterine treatment strategy.

Limitations

Small sample size as a pilot study.
Could not ensure the hypoplasia degrees of isthmus were exactly the same between the oxygen and air groups at baseline.
Lacked statistical power to predict treatment outcomes for individual patients.
Long-term safety of the treatment for babies and mothers remains to be established.
Small sample size
Could not be sure the hypoplasia degrees of isthmus were the same between the oxygen and air groups at baseline
Lack of statistical power to predict treatment outcomes for each individual
Longer follow-up period needed to establish long-term safety

Implication

May support prenatal intervention for fetal coarctation; first RCT extends prior observational data.

Abstract

The aim was to investigate the impact of maternal hyperoxygenation (HO) on cardiac dimensions in fetuses with isolated Coarctation (CoA). Fetal echocardiography was performed serially in 48 fetuses with CoA and gestation age matched normal fetues. The Z-scores for the mitral valve (MV), tricuspid valve (TV), aortic valve (AV), ascending aorta (AAo), isthmus, pulmonary valve (PV), main pulmonary artery (MPA), and descending aorta (DAo) were measured and compared among normal fetuses, CoA fetuses with oxygen and CoA fetuses with air. In the group with oxygen, 6 L/min oxygen was administered to the mother using a face mask. Regression analyses were performed to identify potential factors for HO outcome. The left heart dimension Z-scores increased gradually during HO therapy periods, especially at 4 weeks after oxygen therapy (P < 0.05). As for the case group with air, the left heart dimension remained unchanged. The duration of HO was associated with aortic arch Z-scores (adjusted R 2 = 0.199, 0.60 for AAO and isthmus, respectively). Sustained maternal middle-flow oxygenation can be safely used to improve left heart dimensions in fetuses with isolated CoA. The duration of HO were associated with treatment outcome. These findings may provide useful information for developing novel treatment strategies.

Discussion

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Cite This Study

Zeng et al. (2016) conducted an RCT in Isolated coarctation of the aorta (CoA) (n=96). Maternal hyperoxygenation vs. Room air was evaluated on Postnatal normal aortic arch (p=<0.01). Sustained maternal hyperoxygenation significantly increased the rate of a normal aortic arch postnatally to 70.8% compared to 12.5% with room air in fetuses with isolated coarctation.

synapsesocial.com/papers/6a1f0fcf52be8f5fb3e6cb60 https://doi.org/10.1038/srep39304

Topics

Echocardiography

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Sustained maternal hyperoxygenation improves aortic arch dimensions in fetuses with coarctation

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Sustained maternal hyperoxygenation improves aortic arch dimensions in fetuses with coarctation

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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