1382 Postnatal diagnoses of coarctation of the aorta or hypoplastic aortic arch presenting to a tertiary cardiac centre

Abstract

<h3>Aims</h3> Review of postnatal diagnoses of hypoplastic aortic arch or coarctation of the aorta cases presenting to a tertiary regional cardiac centre. Examining if any common themes in these patients, if there is any lessons to be learned in how we may detect these patients if not done antenatally. <h3>Methods</h3> 5 year review from January 2017 to 2021 of patients admitted to Leeds Teaching Hospitals Trust (LTHT) PICU with a primary diagnosis of Coarctation of the aorta or Hypoplastic aortic arch. The PICANET database was used to create the database. Electronic patient records (PPM) was used to gain further details, which included electronic documentation and any paper notes that had been uploaded. <h3>Results</h3> 133 patients during this time, 120 single patient admissions, of these 48% were Coarctation and 52% Hypoplastic aortic arch. 67% male and 33% female. For postnatal diagnoses there were 64 (53%) cases, with 73% male and 27% female. Coarctation of the aorta made up 66% of postnatal diagnoses, 68% male and 32% female. Age ranges of diagnosis was 1 day to 18months, 16% were picked up by the NIPE exam and 5% by GP exam. 66% of this group had another structural cardiac abnormality, with commonest lesions being VSD (36%), abnormal aortic valve (32%) or hypoplastic aortic arch (24%). 10.5% also had genetic conditions. Hypoplastic aortic arches were 42% of postnatal diagnosis, 19% female and 81% male. 15% were picked up by the NIPE and 4% by GP exam. Age of diagnosis ranged from 1 day to 4years. 96% had another structural cardiac abnormality, the commonest being coarctation of the aorta (88%), VSD (60%) or abnormal aortic valve (24%). 23% also had a genetic condition. Commonest presenting symptoms were weak or absent femorals (44%), signs of respiratory distress (28%) and murmur (27%). 16% in total presented in collapsed state, with 10.5% coarctation patients versus 23% <h3>Conclusion</h3> Both hypoplastic aortic arch and coarctation of the aorta were more common in males. Both had similar presenting features as described in the literature, of weak or absent femorals, murmur, feeding difficulties, respiratory distress or collapse. Coarctation of the aorta is a difficult diagnosis to make antenatally, therefore these cases continue to present in the postnatal period. In the sick newborn infant, weak or absent femorals should prompt concerns and investigations (i.e an echo) for a cardiac lesion. A prostin infusion as per local guidance should be started if concerned about a duct dependent lesion, as this can always be stopped following an echo and may be life saving if that is the diagnosis. Whilst this is a small group of patients from a single centre, limited by information available electronically, there are some useful learning points. If there is a first degree relative with cardiac lesion, it is important to ensure a fetal echo happens. If a murmur is heard on neonatal examination including the NIPE, it is important there is early follow up of this and safety netting with family in place.