Changes of Prenatal Sonographic Vascular Parameters in Coarctation of the Aorta and the Risk Factors

Purpose

To investigate changes in ultrasound vascular parameters in fetuses with coarctation of the aorta (CoA) and risk factors for CoA presence.

Materials and Methods

Fetuses of CoA and healthy controls without CoA confirmed after birth were prospectively enrolled. All ultrasound-related vascular parameters were analyzed.

Results

Forty-five CoA positive fetuses and 336 age-matched (p > 0.05) healthy fetuses were enrolled. Compared with the normal fetuses, CoA positive fetuses exhibited significantly (p < 0.05) different ultrasound parameters. Significant (p < 0.05) independent risk factors of CoA presence were DA diameter, isthmus diameter at 3 vessel trachea view, arch diameter, left common carotid artery (LCCA) to left subclavian artery (LSA) distance, ascending aorta (AAO) diameter, and main pulmonary artery (MPA) diameter. The area under the receiver operating characteristics curve (AUC) and cutoff value were 0.997 and 0.395, respectively, for the overall fitted model $(p=1/[1+e\frac{-(4.85+62.58\times \text{DA diameter}-22.89\times \text{isthmic diameter}-48.76\times \text{arch segment 2 diameter}+31.18\times \text{LCCA-LSA distance}}{-60.82\times \text{AAO diameter}+25.04\times \text{MPA diameter}-20.51\times \text{DAO diameter}-0.003\times \text{DA-Isthmus angle})}]$ with the mean gestational age 28 weeks, 0.704 and 0.33 cm for DA diameter, 0.891 and 0.27 cm for isthmus diameter, 0.808 and 0.26 cm for aortic arch diameter, 0.676 and 0.28 mm for LCCA-LSA distance, 0.707 and 0.39 cm for AAO diameter, and 0.566 and 0.86 cm for MPA diameter, with a high negative predictive value all above 0.90.

Conclusion

CoA positive fetuses exhibit significant differences in prenatal sonographic vascular parameters, and the LCCA-LSA distance and diameter of DA, aortic isthmus, arch, AAO, and MPA are independent risk factors for CoA presence.