Aortic isthmus flow reversal in fetal coarctation of the aorta and the associated factors

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2024-09-16 DOI:10.1111/aogs.14940

Guihong Chen, Yongfeng Han, Congxin Sun, Wei Xiang, Wei Zhao, Pei Zhou, Tianxiao Yu, Zhuo Chen, Bulang Gao, Shuping Ge, Jie Mi

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Abstract

Introduction

The aim of this study was to investigate the presence of aortic isthmus flow reversal and its associated factors in fetuses with positive and false-positive coarctation of the aorta (CoA) compared with normal controls.

Material and Methods

Pregnant women with fetuses suspected of CoA and normal control were enrolled, and these women experienced prenatal ultrasound scan and followed up for 6 months after birth to confirm the presence of CoA. All the ultrasound parameters were analyzed.

Results

A total of 134 pregnant women were enrolled, with 43 CoA-positive fetuses and 91 CoA false-positive fetuses, and 334 matched pregnant women were enrolled in the control group. Aortic isthmus flow reversal occurred in 28 (65.1%) fetuses in the CoA-positive group, significantly (p < 0.05) more than in the false-positive (37 or 40.7%) or control group (64 or 19.2%). Aortic isthmus flow reversal was mostly in the full systole (n = 17 or 60.7%) or late systole and early-middle diastole (n = 10 or 35.7%) in the CoA-positive fetuses (n = 27 or 96.4%), significantly (p < 0.001) different from that in the false-positive or control group. The aortic isthmus flow reversal peak systolic velocity (PSV), flow volume, and ratio of reversed flow/forward flow were significantly (p < 0.05) increased in the CoA-positive and false-positive groups than in the control group. The aortic isthmus flow reversal incidence was significantly (p < 0.05) correlated with the middle cerebral artery (MCA) PSV in the total three groups or in the false-positive group but was significantly (p < 0001) negatively correlated with the MCA resistance index (RI) in the CoA-positive group. The incidence of the aortic isthmus flow reversal was significantly (p < 0.05) positively correlated with the umbilical artery (UA) RI in the false-positive group and with the UA RI in the total three groups. Independently associated factors for aortic isthmus flow reversal were isthmic flow volume/CCO (combined cardiac output) in the CoA-positive group.

Conclusions

Reversal of flow in the aortic isthmus is much more common in true-positive cases of CoA as compared to controls, and isthmic flow reversal in the full systolic phase only suggests presence of CoA. The aortic isthmic reversed flow volume accounts for over half of the isthmic forward flow volume in the CoA-positive fetuses than in the normal controls.

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胎儿主动脉峡部血流逆转及相关因素

引言本研究旨在探讨主动脉瓣狭窄（CoA）阳性和假阳性胎儿与正常对照组相比是否存在主动脉峡部血流逆转及其相关因素。结果共纳入 134 名孕妇，其中有 43 名 CoA 阳性胎儿和 91 名 CoA 假阳性胎儿，对照组纳入 334 名匹配孕妇。CoA阳性组中有28个（65.1%）胎儿出现主动脉峡部血流逆转，显著（p < 0.05）高于假阳性组（37或40.7%）或对照组（64或19.2%）。CoA阳性胎儿（n = 27 或 96.4%）的主动脉峡部血流逆转多发生在完全收缩期（n = 17 或 60.7%）或收缩晚期和舒张早中期（n = 10 或 35.7%），与假阳性组或对照组有明显差异（p < 0.001）。与对照组相比，CoA 阳性组和假阳性组的主动脉峡部血流反向收缩峰值速度（PSV）、血流量和反向血流/正向血流比率均明显增加（p <0.05）。在所有三组或假阳性组中，主动脉峡部血流逆转发生率与大脑中动脉（MCA）PSV 显著相关（p < 0.05），但在 CoA 阳性组中，主动脉峡部血流逆转发生率与 MCA 阻力指数（RI）显著负相关（p < 0001）。在假阳性组中，主动脉峡部血流逆转的发生率与脐动脉（UA）RI 呈显著正相关（p <0.05），而在所有三组中，主动脉峡部血流逆转的发生率与 UA RI 呈显著正相关（p <0.05）。主动脉峡部血流逆转的独立相关因素是 CoA 阳性组的峡部血流量/CCO（合并心输出量）。与正常对照组相比，CoA 阳性胎儿的主动脉峡部反向血流量占峡部正向血流量的一半以上。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.