Additional Predictive Importance of Middle Cerebral Artery, Umbilical Artery and Heart for Coarctation of the Aorta in Fetal Ultrasound Parameters

Purpose

To investigate the ultrasound parameter changes in middle cerebral artery (MCA), intra-abdominal and extra-abdominal umbilical artery (UA), and heart for prediction of fetal coarctation of the aorta (CoA).

Materials and Methods

In this prospective one-center control study, 45 true CoA fetuses, 70 false-positive CoA fetuses, and 336 healthy control fetuses at the gestational age 19–40 weeks were prospectively enrolled to undergo ultrasound examination. All the ultrasound parameters of the MCA, intra-abdominal and extra-abdominal UA, and heart were analyzed for the prediction of true CoA in the fetuses.

Results

In the true CoA fetuses compared with the healthy controls, significant (p < 0.05) decreases were present in the peak systolic velocity (PSV)/peak diastolic velocity ratio (S/D), pulsatility index (PI), resistance index (RI) of the MCA, PSV and velocity time integral (VTI) of the UA, MCA to the intra-abdominal UA ratios of the S/D, PI, and RI, left ventricle, tricuspid valve E peak (TV-E), TV-A peak, left cardiac output (LCO), and LCO/body weight, whereas significant (p < 0.05) increases were detected in the UA S/D, PI, and RI, the MCA to the intra-abdominal UA ratios of the PSV and VTI, cardiac axis, right atrium, and right ventricle. Compared with the true CoA fetuses, the false-positive fetuses exhibited significant (p < 0.05) increases in MCA S/D, intra-abdominal UA PSV and VTI, MCA-S/D/intra-abdominal UA S/D, MCA-PI/intra-abdominal UA-PI, MCA-RI/intra-abdominal UA-RI, MCA-S/D/free UA-S/D, MCA-PI/free UA-PI, MCA-RI/free UA-RI, MV-E, MV E/A, TV-E and -A, and LCO/weight, but significant (p < 0.05) decreases in MCA-VTI/intra-abdominal UA-VTI, intra-abdominal UA PI and RI, free UA S/D, free UA PI and RI, and RCO/weight.

Conclusion

Fetuses with CoA have significant alterations in the ultrasound parameters of MCA, intra-abdominal UA, and heart, and significant decreases in MCA RI and the ratio of LCO to fetal weight and ventricular septal defect may significantly affect CoA presence. Fetuses with these ultrasound changes at the gestational age 19–40 weeks should have further examinations for confirmation of CoA presence.