Precision and impact of prenatal diagnosis in common arterial trunk

Abstract

Outcomes of common arterial trunk (CAT) depend mainly on truncal valve function, coronary artery abnormalities and presence of interrupted aortic arch. To evaluate the precision and the potential impact of prenatal diagnosis of CAT in the current era. Retrospective monocentric analysis of 84 CAT patients from 2011- 2019 including 62 live born with prenatal diagnosis, 16 live born with postnatal diagnosis and 6 terminations of pregnancy with fetopsy. Cohen's Kappa statistic was used to measure agreement for pre- and postnatal assessment of anatomic subtypes according to Van Praagh and of truncal valve function. Mortality and morbidity variables were compared. Diagnostic precision for prenatal diagnosis of CAT subtypes was moderate (Kappa κ= 0.43) with a pre-and postnatal discordance in 19.7%. Notably, no fetus had a prenatal diagnosis of CAT type A3, and only half of patients with CAT type A4 (8/17) were diagnosed prenatally. Fetal evaluation of truncal valve function underestimated the presence and severity of insufficiency (slight agreement; κ= 0.19). However, 4 of 5 postnatally confirmed significant stenoses were diagnosed prenatally (moderate agreement; κ= 0.38). There was no difference in postoperative mortality for CAT patients with or without prenatal diagnosis ( P = 0.87). CAT patients with fetal diagnosis underwent earlier intervention ( P < 0.001), had shorter intubation time ( P = 0.047) and shorter global hospital stay ( P = 0.01). Progress is needed in the prenatal precision of CAT diagnosis, since prostaglandin dependent subtypes 3 and 4 are still largely underdiagnosed during fetal life with potential negative impact on neonatal management strategies. Prenatal assessment of truncal valve function remains difficult, even if valve stenosis seems easier predictable than insufficiency. Prenatal diagnosis of CAT has no impact on mortality but appears to be associated with less postoperative morbidity.