Left Ventricular Strain, Arch Angulation, and Velocity-Time Integral Ratio Improve Performance of a Clinical Pathway for Fetal Diagnosis of Neonatal Coarctation of the Aorta

Abstract

Plain Language SummaryCoarctation of the aorta is challenging to diagnosis in fetal life. New fetal echocardiographic techniques have been developed to help predict the development of surgical coarctation of the aorta after birth but have not been externally validated or compared to each other. We sought to validate these metrics and compare their utility in predicting surgical coarctation of the aorta in a retrospective cohort of previously identified fetuses at risk for coarctation of the aorta. We found that among fetuses with prenatal concern for coarctation of the aorta, novel metrics were significantly different between surgical and non-surgical cases. Our results indicate that the incorporation of novel metrics can add diagnostic value for fetal coarctation of the aorta with higher specificity than previous high-risk criteria, without compromising the sensitivity of the low-risk group. The ability to identify fetuses at the highest risk for surgical coarctation may improve prenatal counseling, allow for more consistent surgical planning, and ultimately optimize hospital resource allocation.