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  • PRENATAL DIAGNOSIS OF FETAL AORTIC COARCTATION• Prenatal diagnosis of fetal aor/c coarctaon ( AoCo) is mainly suspected when cardiac ventricular or great vessels dispropor/on is
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PRENATAL DIAGNOSIS OF FETAL AORTIC COARCTATION • Prenatal diagnosis of fetal aor/c coarcta/on (AoCo) is mainly suspected when cardiac ventricular or great vessels dispropor/on is encountered on prenatal ultrasound. • The aim of this study was to evaluate the detec/on rate of fetal AoCo according to these criteria and to determine echocardiographic features associated with this diagnosis. • Retrospec/ve study between January 2010 and December 2015. • We reviewed the chart of 85 fetus referred for cardiac ventricular or great vessels dispropor/on. • 48 fetus were excluded because of hypoplas/c leJ ventricle, complex heart disease, interrup/on of the aor/c arch. • 37 fetus were included for suspicion of isolated AoCo and noted their postnatal follow-up. We compared the subject with and without AoCo. We analyzed: • the right/leJ ventricular (RV/LV) diameters ra/o • main pulmonary artery/ascending aorta (MPA/AAo) diameters ra/o • ductus arteriosus/aor/c isthmus (DA/AOI) diameters ra/o • presence of reverse flow in the aorta • persistent leJ superior vena cava • ventricular septal defect • bicuspid aor/c valve The postnatal follow up included: • the ultrasound data • /ming of the surgery and the surgical approach. Sta/s/cs: • Results are expressed as percentage and mean. • Chi-square test and T-test are used for the comparison of the group with AoCo confirmed postnatally and the group without AoCo. • Sta/s/cal significance with p value <0,05. The AoCo was confirmed postnatally in 19 neonates (51,4%), all requiring surgical treatment in the neonatal period 7 days aJer birth on average (2 days- 18 days). Significant sta/s/cal differences (p=0,005) were found: • when the diagnosis was suspected during the second trimester ultrasound scan (p=0.005) • when there was a reverse flow in the aorta (21,1% vs 0% p=0,039) • the RV/LF diameters ra/o was significantly higher in case of coarcta/on at the third trimester (1,82 vs 1,30 p<0,001). There was no significant difference for: • the RV/LF diameters ra/o at the second trimester (p=0183) • the MPA/AAo diameters ra/o (p=0,132) • the DA/AOI diameters ra/o (p=0,079) • ventricular septal defect, persistent leJ superior vena cava, prenatal diagnosis of bicuspid aor/c valve. Conclusion: Cardiac ventricular or great vessels dispropor@on is not a specific sign for the prenatal diagnos@c of aor@c coarcta@on. Further studies are needed to build predic@on models integra@ng different ultrasound signs in order to improve the antenatal detec@on of this anomaly. Figure 1: Four chamber view 2sd trimester: AoCo+: ventricular dispropor/on . VD=RV, VG=LV, OD=RA, OG=LA. Figure 3: Three vessels view: AoCo+: MPA/AAo=1,87. AP=MPA, AO=Aao. Figure 5: Three vessels and trachea view: AoCo-: DA/AOI=1,07 No reverse flow in the aorta AP=MPA, AO=AOI, CA=DA. Figure 4: Three vessels and trachea view: AoCo+: great vessels dispropor/on Reverse flow in the aorta Figure 6: Three vessels view: visualiza/on of a 4th vessel: leJ superior vena cava Figure 2: Four chamber view 3th trimester: AoCo+: ventricular dispropor/on. VD=RV, VG=LV, OD=RA, OG=LA. Figure 8: LeJ oudlow tract view: ventricular septal defect Objec@ves Methods Results Figure 7: Bicuspid aor/c valve Meysonnier C.(1) , Massoud M.(1), Joly H.(2)(3), Bonnet C.(2), Veyrier M.(2), Di Filipo S.(2), Pangaud N.(2)(3). (1) Centre Pluridisciplinaire de Diagnos/c Prénatal, Hôpital Femme Mère Enfant Lyon-Bron, France. (2) Service de Cardiologie Pédiatrique, Hospices Civils de Lyon, Lyon-Bron, France. (3) Cabinet de Cardiologie Pédiatrique et Fœtale, Médicentre du Val d’Ouest, Ecully, France. Aortic coarctation confirmed No Aortic coarctation P value Ultrasound scan 2sd trimester 14 (73,7%) 5 (27,8%) *0,005 3th trimester 5 (26,3%) 13 (72,2%) *0,005 Cardiac ventricular disproportion LV mm (average) 7,98 (5,6-10,8) 10,63 (6-14,8) RV mm (average) 13,39 (9-21) 14,14 (8-21) RV/LV ratio 2sd trimester (average) 1,63 (1,28-2) 1,47 (1,1-1,8) 0,183 RV/LV ratio 3th trimester (average) 1,82 (1,57-2,33) 1,3 (1,12-1,7) *<0,001 Great vessels disproportion AAo mm (average) 4,43 (2,2-7) 5,96 (4,2-7,8) MPA mm (average) 7,49 (4-11) 8,86 (7,3-12) MPA/Aao ratio (average) 1,81 (1,34-3,66) 1,55 (1,06-2) 0,132 Aortic isthmus/Ductus arteriosus Aortic isthmus not viewed 11 (57,9%) 4 (22,2%) *0,027 AOI mm (average) 1,04 (0-3) 2,47 (0-3,5) DA not documented 11 (57,9%) 9 (50%) 0,63 DA/AOI ratio (average) 3,14 (1,6-5) 1,93 (1,23-5) 0,079 Doppler reverse flow in the aorta 4 (21,1%) 0 (0%) *0,039 Associated diseases ventricular septal defect 8 (42,1%) 7 (38,9%) 0,842 persistant left superior vena cava 2 (10,5%) 4 (22,2%) 0,335 bicuspid aortic valve 5 (26,3%) 3 (16,7%) 0,476

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Page 1: PRENATAL DIAGNOSIS OF FETAL AORTIC COARCTATION• Prenatal diagnosis of fetal aor/c coarctaon ( AoCo) is mainly suspected when cardiac ventricular or great vessels dispropor/on is

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@[email protected]@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

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