prenatal diagnosis of fetal aortic coarctation• prenatal diagnosis of fetal aor/c coarctaon (...
Post on 21-Jan-2021
1 Views
Preview:
TRANSCRIPT
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
top related