prenatal diagnosis of fetal aortic coarctation• prenatal diagnosis of fetal aor/c coarctaon (...

PRENATALDIAGNOSISOFFETALAORTICCOARCTATION

•  Prenataldiagnosisoffetalaor/ccoarcta/on(AoCo)ismainlysuspectedwhencardiacventricularorgreatvesselsdispropor/onisencounteredonprenatalultrasound.

•  Theaimofthisstudywastoevaluatethedetec/onrateoffetalAoCoaccording to these criteria and to determine echocardiographicfeaturesassociatedwiththisdiagnosis.

•  Retrospec/vestudybetweenJanuary2010andDecember2015.•  We reviewed the chart of 85 fetus referred for cardiac ventricular or

greatvesselsdispropor/on.•  48 fetuswereexcludedbecauseofhypoplas/c leJventricle, complex

heartdisease,interrup/onoftheaor/carch.•  37fetuswere includedforsuspicionof isolatedAoCoandnotedtheir

postnatalfollow-up.WecomparedthesubjectwithandwithoutAoCo.Weanalyzed:•  theright/leJventricular(RV/LV)diametersra/o•  mainpulmonaryartery/ascendingaorta(MPA/AAo)diametersra/o•  ductusarteriosus/aor/cisthmus(DA/AOI)diametersra/o•  presenceofreverseflowintheaorta•  persistentleJsuperiorvenacava•  ventricularseptaldefect•  bicuspidaor/cvalveThepostnatalfollowupincluded:•  theultrasounddata•  /mingofthesurgeryandthesurgicalapproach.Sta/s/cs:•  Resultsareexpressedaspercentageandmean.•  Chi-squaretestandT-testareusedforthecomparisonofthegroupwithAoCoconfirmedpostnatallyandthegroupwithoutAoCo.•  Sta/s/calsignificancewithpvalue<0,05.

The AoCo was confirmed postnatally in 19 neonates (51,4%), all requiringsurgical treatment in the neonatal period 7 days aJer birth on average (2days-18days).Significantsta/s/caldifferences(p=0,005)werefound:•  whenthediagnosiswassuspectedduringthesecondtrimesterultrasound

scan(p=0.005)•  whentherewasareverseflowintheaorta(21,1%vs0%p=0,039)•  theRV/LFdiametersra/owassignificantlyhigherincaseofcoarcta/onat

thethirdtrimester(1,82vs1,30p<0,001).Therewasnosignificantdifferencefor:•  theRV/LFdiametersra/oatthesecondtrimester(p=0183)•  theMPA/AAodiametersra/o(p=0,132)•  theDA/AOIdiametersra/o(p=0,079)•  ventricular septal defect, persistent leJ superior vena cava, prenatal

diagnosisofbicuspidaor/cvalve.

Conclusion:Cardiacventricularorgreatvesselsdispropor@onisnotaspecificsignfortheprenataldiagnos@cofaor@ccoarcta@on.Furtherstudiesareneededtobuildpredic@onmodelsintegra@ngdifferentultrasoundsignsinordertoimprovetheantenataldetec@onofthisanomaly.

Figure1:Fourchamberview2sdtrimester:AoCo+:ventriculardispropor/on.VD=RV,VG=LV,OD=RA,OG=LA.

Figure3:Threevesselsview:AoCo+:MPA/AAo=1,87.AP=MPA,AO=Aao.

Figure5:Threevesselsandtracheaview:AoCo-:DA/AOI=1,07NoreverseflowintheaortaAP=MPA,AO=AOI,CA=DA.

Figure4:Threevesselsandtracheaview:AoCo+:greatvesselsdispropor/onReverseflowintheaorta

Figure6:Threevesselsview:visualiza/onofa4thvessel:leJsuperiorvenacava

Figure2:Fourchamberview3thtrimester:AoCo+:ventriculardispropor/on.VD=RV,VG=LV,OD=RA,OG=LA.

Figure8:LeJoudlowtractview:ventricularseptaldefect

Objec@ves

Methods

Results

Figure7:Bicuspidaor/cvalve

MeysonnierC.(1),MassoudM.(1),JolyH.(2)(3),BonnetC.(2),VeyrierM.(2),DiFilipoS.(2),PangaudN.(2)(3).(1)CentrePluridisciplinairedeDiagnos/cPrénatal,HôpitalFemmeMèreEnfantLyon-Bron,France.(2)ServicedeCardiologiePédiatrique,HospicesCivilsdeLyon,Lyon-Bron,France.(3)CabinetdeCardiologiePédiatriqueetFœtale,MédicentreduVald’Ouest,Ecully,France.

Aorticcoarctationconfirmed NoAorticcoarctation PvalueUltrasoundscan2sdtrimester 14 (73,7%) 5 (27,8%) *0,0053thtrimester 5 (26,3%) 13 (72,2%) *0,005CardiacventriculardisproportionLVmm(average) 7,98 (5,6-10,8) 10,63 (6-14,8)RVmm(average) 13,39 (9-21) 14,14 (8-21)RV/LVratio2sdtrimester(average) 1,63 (1,28-2) 1,47 (1,1-1,8) 0,183RV/LVratio3thtrimester(average) 1,82 (1,57-2,33) 1,3 (1,12-1,7) *<0,001GreatvesselsdisproportionAAomm(average) 4,43 (2,2-7) 5,96 (4,2-7,8)MPAmm(average) 7,49 (4-11) 8,86 (7,3-12)MPA/Aaoratio(average) 1,81 (1,34-3,66) 1,55 (1,06-2) 0,132Aorticisthmus/DuctusarteriosusAorticisthmusnotviewed 11 (57,9%) 4 (22,2%) *0,027AOImm(average) 1,04 (0-3) 2,47 (0-3,5)DAnotdocumented 11 (57,9%) 9 (50%) 0,63DA/AOIratio(average) 3,14 (1,6-5) 1,93 (1,23-5) 0,079Dopplerreverseflowintheaorta 4 (21,1%) 0 (0%) *0,039Associateddiseasesventricularseptaldefect 8 (42,1%) 7 (38,9%) 0,842persistantleftsuperiorvenacava 2 (10,5%) 4 (22,2%) 0,335bicuspidaorticvalve 5 (26,3%) 3 (16,7%) 0,476