Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College at Queen Charlotte's and Chelsea Hospital, London, UK.
Ultrasound Obstet Gynecol. 2012 Jul;40(1):47-54. doi: 10.1002/uog.11161. Epub 2012 Jun 15.
Isolated fetal coarctation of the aorta (CoA) has high false-positive diagnostic rates by cardiologists in tertiary centers. Isthmal diameter Z-scores (I), ratio of isthmus to duct diameters (I:D), and visualization of CoA shelf (Shelf) and isthmal flow disturbance (Flow) distinguish hypoplastic from normal aortic arches in retrospective studies, but their ability to predict a need for perinatal surgery is unknown. The aim of this study was to determine whether these four sonographic features could differentiate prenatally cases which would require neonatal surgery in a prospective cohort diagnosed with CoA by a cardiologist.
From 83 referrals with cardiac disproportion (January 2006 to August 2010), we identified 37 consecutive fetuses diagnosed with CoA. Measurements of I and I:D were made and the presence of Shelf or Flow recorded. Sensitivity, specificity and areas under receiver-operating characteristics curves, using previously reported limits of I < - 2 and I:D < 0.74, as well as Shelf and Flow were compared at first and final scan. Associations between surgery and predictors were compared using multivariable logistic regression and changes in measurements using ANCOVA.
Among the 37 fetuses, 30 (81.1%) required surgery and two with an initial diagnosis of CoA were revised to normal following isthmal growth, giving an 86% diagnostic accuracy at term. The median age at first scan was 22.4 (range. 16.6-7.0) weeks and the median number of scans per fetus was three (range, one to five). I < - 2 at final scan was the most powerful predictor (odds ratio, 3.6 (95% CI, 0.47-27.3)). Shelf was identified in 66% and Flow in 50% of fetuses with CoA.
Incorporation of these four sonographic parameters in the assessment of fetuses with suspected CoA at a tertiary center resulted in better diagnostic precision regarding which cases would require neonatal surgery than has been reported previously.
在三级中心，孤立性胎儿主动脉缩窄（CoA）的心脏病专家的假阳性诊断率很高。在回顾性研究中，峡部直径 Z 分数（I）、峡部与导管直径比（I:D）以及 CoA 支架（Shelf）和峡部血流紊乱（Flow）的可视化可区分发育不良的主动脉弓和正常的主动脉弓，但它们预测围生期手术需求的能力尚不清楚。本研究旨在确定这四种超声特征是否能在由心脏病专家诊断为 CoA 的前瞻性队列中区分出需要新生儿手术的病例。
从 2006 年 1 月至 2010 年 8 月的 83 例心脏比例失调的转诊患者中，我们确定了 37 例连续胎儿被诊断为 CoA。测量 I 和 I:D，并记录 Shelf 或 Flow 的存在。使用先前报道的 I < - 2 和 I:D < 0.74 的限制，以及 Shelf 和 Flow，比较第一次和最后一次扫描的灵敏度、特异性和受试者工作特征曲线下面积。使用多变量逻辑回归和协方差分析（ANCOVA）比较手术和预测因素之间的关联以及测量值的变化。
在 37 例胎儿中，30 例（81.1%）需要手术，2 例最初诊断为 CoA 的病例在峡部生长后被修正为正常，这使得在足月时诊断准确率达到 86%。第一次扫描的中位年龄为 22.4 周（范围 16.6-7.0 周），每个胎儿的中位扫描次数为 3 次（范围 1 次至 5 次）。最后一次扫描时 I < - 2 是最有力的预测因素（比值比，3.6（95%CI，0.47-27.3））。在 CoA 胎儿中，66%的胎儿可识别 Shelf，50%的胎儿可识别 Flow。
在三级中心，对疑似 CoA 的胎儿进行评估时纳入这四个超声参数，与之前报道的结果相比，提高了诊断精度，从而更好地确定了哪些病例需要新生儿手术。
