Skip to main content
SpringerLink
Log in

Validation of Prenatal Aortic Arch Angle Measurements in the Diagnosis of Neonatal Coarctation of the Aorta

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Prenatal prediction of coarctation of the aorta (CoA) is challenging. Methods identifying prenatal CoA have high sensitivity with significant false positives. We previously derived prenatal aortic arch angles for identifying CoA with high sensitivity and specificity and aim to validate these angles and compare them with a model utilizing ascending aorta (AAo) and isthmus (Aoi) measures. Retrospective case/cohort study of fetuses with prenatal suspicion for CoA. 35 fetuses were included. Measurements included: ascending—descending aortic angle (AAo.DAo), transverse—descending aortic angle (TAo.DAo); diameters and z-scores of Aoi from sagittal (Aoi-sag), three-vessel (Aoi-3VV) view and AAo. Discriminant functions for the 5 variables were compared using histograms and positive/negative predictive values (PPV/NPV). CoA was confirmed in 28/35 neonates. The PPV and NPV for angle measures were 100% and 77%. The AAo + Aoi-3VV model PPV and NPV were 92% and 80% and Aoi-sag + Aoi-3VV model were 82% and 71%. A linear discriminant model utilizing the 3 most predictive variables improved NPV to 90% and PPV to 100%. In conclusion, we validate that angle measures are superior to standard models of predicting CoA. An optimized 3 variable model maintains accuracy of identifying CoA while eliminating false positives.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

Data not shared.

References

  1. Kailin JA, Santos AB, Yilmaz Furtun B, Sexson Tejtel SK, Lantin-Hermoso R (2017) Isolated coarctation of the aorta in the fetus: a diagnostic challenge. Echocardiography 34(12):1768–1775

    Article  PubMed  Google Scholar 

  2. Familiari A, Morlando M, Khalil A et al (2017) Risk factors for coarctation of the aorta on prenatal ultrasound: a systematic review and meta-analysis. Circulation 135(8):772–785

    Article  PubMed  Google Scholar 

  3. Franklin O, Burch M, Manning N, Sleeman K, Gould S, Archer N (2002) Prenatal diagnosis of coarctation of the aorta improves survival and reduces morbidity. Heart 87(1):67–69

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Robert Morrow W, Huhta JC, Murphy DJ, McNamara DG (1986) Quantitative morphology of the aortic arch in neonatal coarctation. J Am Coll Cardiol 8(3):616–620

    Article  Google Scholar 

  5. Gómez-Montes E, Herraiz I, Gómez-Arriaga PI, Escribano D, Mendoza A, Galindo A (2014) Gestational age-specific scoring systems for the prediction of coarctation of the aorta. Prenat Diagn 34(12):1198–1206

    Article  PubMed  Google Scholar 

  6. Wang H, Lei W, Liu J, Yang B, Li H, Huang D (2019) The diastolic and systolic velocity time integral ratio of aortic isthmus is a sensitive indicator of aortic coarctation in fetuses. Ultrasound Obstet Gynecol 32:1470–1476

    Google Scholar 

  7. Arya B, Bhat A, Vernon M, Conwell J, Lewin M (2016) Utility of novel fetal echocardiographic morphometric measures of the aortic arch in the diagnosis of neonatal coarctation of the aorta. Prenat Diagn 36(2):127–134

    Article  PubMed  Google Scholar 

  8. Balluffi A, Kassam-Adams N, Kazak A, Tucker M, Dominguez T, Helfaer M (2004) Traumatic stress in parents of children admitted to the pediatric intensive care unit. Pediatr Crit Care Med 5(6):547–553

    Article  PubMed  Google Scholar 

  9. García S, Ruza F, Alvarado F et al (1997) Analysis of costs in a pediatric ICU. Intensive Care Med 23(2):218–225

    Article  PubMed  Google Scholar 

  10. Evers PD, Ranade D, Lewin M, Arya B (2017) Diagnostic approach in fetal coarctation of the aorta: a cost-utility analysis. J Am Soc Echocardiogr 30(6):589–594

    Article  PubMed  Google Scholar 

  11. McElhinney DB, Marshall AC, Wilkins-Haug LE et al (2009) Predictors of technical success and postnatal biventricular outcome after in utero aortic valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome. Circulation 120(15):1482–1490

    Article  PubMed  PubMed Central  Google Scholar 

  12. Schneider C, McCrindle BW, Carvalho JS, Hornberger LK, McCarthy KP, Daubeney PEF (2005) Development of Z-scores for fetal cardiac dimensions from echocardiography. Ultrasound Obstet Gynecol 26(6):599–605

    Article  CAS  PubMed  Google Scholar 

  13. Krishnan A, Pike JI, McCarter R et al (2016) Predictive models for normal fetal cardiac structures. J Am Soc Echocardiogr 29(12):1197–1206

    Article  PubMed  Google Scholar 

  14. Pasquint L, Mellander M, Seale A et al (2007) Z-scores of the fetal aortic isthmus and duct: an aid to assessing arch hypoplasia. Ultrasound Obstet Gynecol 29(6):628–633

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, Seattle Children’s Hospital and University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Kaitlyn Freeman, Michele Clouse, Jeffrey Conwell, Aarti Bhat, Luciana Young, Mark Lewin & Bhawna Arya

  2. Department of Biostatistics and Collaborative Health Studies, Magnuson Health Sciences Center, University of Washington, F-600, Seattle, WA, 98195, USA

    Richard Kronmal

Authors
  1. Kaitlyn Freeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard Kronmal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michele Clouse
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeffrey Conwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aarti Bhat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luciana Young
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mark Lewin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bhawna Arya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kaitlyn Freeman.

Ethics declarations

Conflict of interest

No conflict of interest has been declared by the author(s).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Freeman, K., Kronmal, R., Clouse, M. et al. Validation of Prenatal Aortic Arch Angle Measurements in the Diagnosis of Neonatal Coarctation of the Aorta. Pediatr Cardiol 42, 1365–1371 (2021). https://doi.org/10.1007/s00246-021-02620-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-021-02620-2

Keywords

Search

Navigation