Key result
Retrograde aortic isthmus flow linked to ~7-fold higher odds of surgical repair in fetal CoA.
Why the study?
The study aimed to investigate fetal echocardiographic findings to predict the need for surgical repair in fetuses with coarctation of the aorta and to evaluate perinatal outcomes.
Do specific fetal echocardiographic findings predict the need for early surgical repair in fetuses with isolated coarctation of the aorta?
Observational
No
Do specific fetal echocardiographic findings predict the need for early surgical repair in fetuses with isolated coarctation of the aorta?
Odds Ratio: 7.43 (95% CI 1.98–27.76)
Specific fetal echocardiographic findings can be integrated into a scoring system to predict the need for early surgical repair in fetuses with isolated coarctation of the aorta.
May refine fetal CoA risk stratification; leaves open prospective validation before changing practice.
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: = 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..
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Akalın et al. (2022) conducted an observational in Coarctation of the aorta (CoA). Fetal echocardiographic findings (e.g., retrograde flow in the aortic isthmus) vs. Absence of these findings was evaluated on Need for surgical repair (OR 7.43, 95% CI 1.98-27.76). Retrograde flow in the aortic isthmus (OR 7.43; 95% CI 1.98-27.76), left-to-right foramen ovale shunt, and ventricular septal defect predicted the need for surgical repair in fetuses with CoA.
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