Alessandra Familiari1, Maddalena Morlando1, Asma Khalil1, Sven-Erik Sonesson1, Carolina Scala1, Giuseppe Rizzo1, Gelsomina Del Sordo1, Chiara Vassallo1, Maria Elena Flacco1, Lamberto Manzoli1, Antonio Lanzone1, Giovanni Scambia1, Ganesh Acharya1, Francesco D'Antonio2. 1. From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.). 2. From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.). francesco.dantonio@uit.no.
Abstract
BACKGROUND: Prenatal diagnosis of coarctation of the aorta (CoA) is still challenging and affected by high rates of false-positive diagnoses. The aim of this study was to ascertain the strength of association and to quantify the diagnostic accuracy of different ultrasound signs in predicting CoA prenatally. METHODS: Medline, Embase, CINAHL, and Cochrane databases were searched. Random-effects and hierarchical summary receiver operating characteristic model meta-analyses were used to analyze the data. RESULTS: Seven hundred ninety-four articles were identified, and 12 (922 fetuses at risk for CoA) articles were included. Mean mitral valve diameter z score was lower (P<0.001) and the mean tricuspid valve diameter z score was higher in fetuses with CoA than in those without CoA (P=0.01). Mean aortic valve diameter z score was lower in fetuses with CoA than in healthy fetuses (P≤0.001), but the ascending aorta diameter, expressed as z score or millimeters, was similar between groups (P=0.07 and 0.47, respectively). Mean aortic isthmus diameter z scores measured either in sagittal (P=0.02) or in 3-vessel trachea view (P<0.001) were lower in fetuses with CoA. Conversely, the mean pulmonary artery diameter z score, the right/left ventricular and pulmonary artery/ascending aorta diameter ratios were higher (P<0.001, P=0.02, and P=0.02, respectively) in fetuses with CoA in comparison with controls, although aortic isthmus/arterial duct diameter ratio was lower in fetuses with CoA than in those without CoA (P<0.001). The presence of coarctation shelf and aortic arch hypoplasia were more common in fetuses with CoA than in controls (odds ratio, 26.0; 95% confidence interval, 4.42-153; P<0.001 and odds ratio, 38.2; 95% confidence interval, 3.01-486; P=0.005), whereas persistent left superior vena cava (P=0.85), ventricular septal defect (P=0.12), and bicuspid aortic valve (P=0.14) did not carry an increased risk for this anomaly. Multiparametric diagnostic models integrating different ultrasound signs for the detection of CoA were associated with an increased detection rate. CONCLUSIONS: The detection rate of CoA may improve when a multiple-criteria prediction model is adopted. Further large multicenter studies sharing the same imaging protocols are needed to develop objective models for risk assessment in these fetuses.
BACKGROUND: Prenatal diagnosis of coarctation of the aorta (CoA) is still challenging and affected by high rates of false-positive diagnoses. The aim of this study was to ascertain the strength of association and to quantify the diagnostic accuracy of different ultrasound signs in predicting CoA prenatally. METHODS: Medline, Embase, CINAHL, and Cochrane databases were searched. Random-effects and hierarchical summary receiver operating characteristic model meta-analyses were used to analyze the data. RESULTS: Seven hundred ninety-four articles were identified, and 12 (922 fetuses at risk for CoA) articles were included. Mean mitral valve diameter z score was lower (P<0.001) and the mean tricuspid valve diameter z score was higher in fetuses with CoA than in those without CoA (P=0.01). Mean aortic valve diameter z score was lower in fetuses with CoA than in healthy fetuses (P≤0.001), but the ascending aorta diameter, expressed as z score or millimeters, was similar between groups (P=0.07 and 0.47, respectively). Mean aortic isthmus diameter z scores measured either in sagittal (P=0.02) or in 3-vessel trachea view (P<0.001) were lower in fetuses with CoA. Conversely, the mean pulmonary artery diameter z score, the right/left ventricular and pulmonary artery/ascending aorta diameter ratios were higher (P<0.001, P=0.02, and P=0.02, respectively) in fetuses with CoA in comparison with controls, although aortic isthmus/arterial duct diameter ratio was lower in fetuses with CoA than in those without CoA (P<0.001). The presence of coarctation shelf and aortic arch hypoplasia were more common in fetuses with CoA than in controls (odds ratio, 26.0; 95% confidence interval, 4.42-153; P<0.001 and odds ratio, 38.2; 95% confidence interval, 3.01-486; P=0.005), whereas persistent left superior vena cava (P=0.85), ventricular septal defect (P=0.12), and bicuspid aortic valve (P=0.14) did not carry an increased risk for this anomaly. Multiparametric diagnostic models integrating different ultrasound signs for the detection of CoA were associated with an increased detection rate. CONCLUSIONS: The detection rate of CoA may improve when a multiple-criteria prediction model is adopted. Further large multicenter studies sharing the same imaging protocols are needed to develop objective models for risk assessment in these fetuses.
Authors: Sharman P Tan Tanny; Sebastian K King; Assia Comella; Alisa Hawley; Jo-Anne Brooks; Rod W Hunt; Bryn Jones; Warwick J Teague Journal: Pediatr Surg Int Date: 2021-01-02 Impact factor: 1.827
Authors: Michal Schäfer; Gareth J Morgan; Max B Mitchell; Michael Ross; Alex J Barker; Kendall S Hunter; Brian Fonseca; Michael DiMaria; Daniel Vargas; D Dunbar Ivy; Neil Wilson; Lorna P Browne Journal: Int J Cardiovasc Imaging Date: 2018-04-17 Impact factor: 2.357
Authors: David F A Lloyd; Kuberan Pushparajah; John M Simpson; Joshua F P van Amerom; Milou P M van Poppel; Alexander Schulz; Bernard Kainz; Maria Deprez; Maelene Lohezic; Joanna Allsop; Sujeev Mathur; Hannah Bellsham-Revell; Trisha Vigneswaran; Marietta Charakida; Owen Miller; Vita Zidere; Gurleen Sharland; Mary Rutherford; Joseph V Hajnal; Reza Razavi Journal: Lancet Date: 2019-03-22 Impact factor: 202.731