RSS-Feed abonnieren
DOI: 10.1055/s-2008-1027556
© Georg Thieme Verlag KG Stuttgart · New York
Course and Outcome of Fetuses Suspected of Having Coarctation of the Aorta during Gestation
Outcome von Feten mit pränatalem echokardiografischem Hinweis für eine AortenisthmusstenosePublikationsverlauf
received: 28.2.2008
accepted: 9.5.2008
Publikationsdatum:
04. September 2008 (online)

Zusammenfassung
Ziel: Bericht über den Schwangerschaftsverlauf und -ausgang bei Feten mit pränatalem Verdacht auf Aortenisthmusstenose. Material und Methoden: Retrospektive Observationsstudie über den Zeitraum von 1993 – 2005 an zwei tertiären Zentren. Ergebnisse: 96 Feten wurden untersucht, davon waren 52 Lebendgeburten. Von 52 Lebendgeburten hatten 34 eine Aortenisthmusstenose, die postnatal durch Echokardiografie bestätigt wurde (65,4 %), 13 Neugeborene hatten zusätzlich, pränatal diagnostizierte, kardiale Anomalien (Ventrikelseptumdefekt, Vorhofseptumdefekt Typ I, Aorten- und Pulmonalstenose, persistierende linke obere Hohlvene) und drei Neugeborene hatten eine Linksherzhypoplasie. Drei Neugeborene wiesen zusätzliche extrakardiale Anomalien auf, die pränatal diagnostiziert wurden (Hypospadie, Mikroophtalmie, Omphalozele, Zwerchfellhernie). 22 Neugeborene wurden operiert, 19 innerhalb der ersten zehn Lebenstage. Ein Neugeborenes entwickelte erst am 14. Lebenstag klinische Zeichen einer Aortenisthmusstenose. Die operative Mortalität betrug 3 / 22 (13,6 %) und diese war durch Frühgeburtlichkeit mitbeeinflusst. Die Überlebensrate auf der Basis intention-to-treat war 29 / 34 Neugeborenen mit bestätigter Aortenisthmusstenose (85,3 %). Zusammenfassung: Die Diagnose einer Aortenisthmusstenose beim Feten ist mit falsch positiven Befunden behaftet. Die Möglichkeit der intrauterinen Progression einer Hypoplasie der Linksherzstrukturen im Falle einer fetalen Aortenisthmusstenose mit der Entwicklung eines Erscheinungsbilds eines hypoplastischen Linksherzens sollte bedacht werden, und aus diesem Grund sind serielle antenatale Echokardiografien zu empfehlen.
Abstract
Purpose: To report the course and outcome of a group of fetuses with prenatal suspicion of coarctation of the aorta. Materials and Methods: Retrospective observational study in two tertiary fetal cardiology centers between 1993 – 2005. Results: 96 fetuses of whom 52 infants were born alive were studied. Of the 52 liveborn infants, 34 had coarctation of the aorta (65.4 %), thirteen had prenatally diagnosed additional cardiac anomalies (VSD, ASD, aortic and pulmonary stenosis, persistent left superior vena cava) and three were managed as having hypoplastic left heart syndrome. Three neonates had additional extracardiac malformations diagnosed prenatally. 22 neonates underwent surgery, nineteen within the first ten days of life. One neonate only developed clinical signs of coarctation on the fourteenth day of life. The early surgical mortality was three of 22 (13.6 %). The mortality was influenced by prematurity. The survival rate on the basis of intention-to-treat was twenty-nine of 34 neonates with confirmed coarctation (85.3 %). Conclusion: Coarctation of aorta during fetal life continues to be a difficult diagnosis. The potential of progressive hypoplasia of left heart structures during gestation in the case of fetal aortic isthmus stenosis with the development of a hypoplastic left heart should be kept in mind and therefore sequential echo-cardiography is recommended during gestation.
Key words
fetus - ultrasound - echocardiography
References
- 1
Allan L D, Sharland G K, Milburn A. et al .
Prospective diagnosis of 1006 consecutive cases of congenital heart disease in the
fetus.
J Am Coll Cardiol.
1994;
23
1452-1458
MissingFormLabel
- 2
Tegnander E, Williams W, Johansen O J. et al .
Prenatal detection of heart defects in a non-selected population of 30,149 fetuses
– detection rates and outcome.
Ultrasound Obstet Gynecol.
2006;
27
252-265
MissingFormLabel
- 3
Copel J A, Tan A SA, Kleinman C S.
Does prenatal diagnosis of congenital heart disease alter short-term outcome?.
Ultrasound Obstet Gynecol.
1997;
10
237-241
MissingFormLabel
- 4
Eapen R S, Rowland D G, Franklin W H.
Effect of prenatal diagnosis of critical left heart obstruction on perinatal morbidity
and mortality.
Am J Perinatol.
1998;
14
237-241
MissingFormLabel
- 5
Kumar R K, Newburger J W, Gauvreau K. et al .
Comparison of outcome when hypoplastic left heart and transposition of the great arteries
are diagnosed prenatally versus when diagnosis of these two conditions is made only
postnatally.
Am J Cardiol.
1999;
83
1649-1653
MissingFormLabel
- 6
Franklin O, Burch M, Manning N. et al .
Prenatal diagnosis of coarctation improves survival and reduces morbidity.
Heart.
2002;
87
67-69
MissingFormLabel
- 7
Bonnet D, Coltri A, Butera G. et al .
Detection of transposition of the great arteries in fetuses reduces neonatal morbidity
and mortality.
Circulation.
1999;
99
916-918
MissingFormLabel
- 8
Tworeztky W, McElhinney D, Reddy V. et al .
Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome.
Circulation.
2001;
103
1269-1273
MissingFormLabel
- 9
Paladini D, Volpe P, Russo M G. et al .
Aortic coarctation: prognostic indicators of survival in the fetus.
Heart.
2004;
90
1348-1349
MissingFormLabel
- 10
Sharland G K, Chan K Y, Allan L D.
Coarctation of the aorta: difficulties in prenatal diagnosis.
Br Heart J.
1994;
71
70-75
MissingFormLabel
- 11
Brown D L, Durfee S M, Hornberger L K.
Ventricular discrepancy as a sonographic sign of coarctation of the fetal aorta: how
reliable is it?.
J Ultrasound Med.
1997;
16
95-99
MissingFormLabel
- 12
Hornberger L K, Sahn D J, Kleinman C S. et al .
Antenatal diagnosis of coarctation of the aorta: a multicenter experience.
J Am Coll Cardiol.
1994;
23
417-423
MissingFormLabel
- 13
Head C E, Jowett V C, Sharland G K. et al .
Timing and presentation and postnatal outcome of infants suspected of having coarctation
of the aorta during fetal life.
Heart.
2005;
91
1070-1074
MissingFormLabel
- 14
Hornberger L K, Weintraub R G, Pesonen E. et al .
Ecocardiographic study of the morphology and growth of the aortic arch in the human
fetus. Observations related to prenatal diagnosis of coarctation.
Circulation.
1992;
86
741-747
MissingFormLabel
- 15
Pasquini L, Fichera A, Tan T. et al .
Left superior caval vein: a powerful indicator of fetal coarctation.
Heart.
2005;
91
539-540
MissingFormLabel
- 16
Pasquini L, Mellander M, Seale A. et al .
Z-scores of the fetal aortic isthmus and duct: an aid to assessing arch hypoplasia.
Ultrasound Obstet Gynecol.
2007;
29
628-633
MissingFormLabel
- 17
Achiron R, Zimand S, Hegesh J. et al .
Fetal aortic arch measurements between 14 and 38 weeks’ gestation: in-utero ultrasonographic
study.
Ultrasound Obstet Gynecol.
2000;
15
226-230
MissingFormLabel
- 18
Nomiyama M, Ueda T, Toyota Y. et al .
Fetal aortic isthmal growth and morphology in late gestation.
Ultrasound Obstet Gynecol.
2002;
19
153-157
MissingFormLabel
- 19
Allan L D.
Evolution of echocardiographic findings in the fetus (editorial).
Circulation.
1997;
96
391-392
MissingFormLabel
- 20
Hornberger L K, Sanders S, Rein A. et al .
Left heart obstructive lesions and left ventricular growth in the midtrimester fetus.
Circulation.
1995;
92
1531-1538
MissingFormLabel
- 21
Elzenga N J, Gittenberger de Groot A C.
Localised coarctation of the aorta: an age dependent spectrum.
Br J Heart.
1983;
49
317-323
MissingFormLabel
- 22
Ho S Y, Anderson R H.
Coarctation, tubular hypoplasia and ductus arteriosus: histological study of 35 specimens.
Br Heart J.
1979;
41
268-274
MissingFormLabel
- 23 Hornberger L K. Aortic arch anomalies. Lindsey A, Lisa H, Gurleen S Textbook of fetal cardiology London; Greenwich Medical Media 2000: 307-331
MissingFormLabel
- 24
Gill H K, Splitt M, Sharland G K. et al .
Patterns of recurrence of congenital heart disease: an analysis of 6640 consecutive
pregnancies evaluated by detailed echocardiography.
J Am Coll Cardiol.
2003;
42
923-929
MissingFormLabel
- 25
Yagel S, Cohen S M, Achiron R.
Examination of the fetal heart by five short-axis views: a proposal screening method
for comprehensive cardiac evaluation (editorial).
Ultrasound Obstet Gynecol.
2001;
17
367-369
MissingFormLabel
- 26
ISUOG .
Cardiac screening examination of the fetus: guidelines for performing the ‘basic`
and ‘extended basic` cardiac scan.
Ultrasound Obstet Gynecol.
2006;
27
107-113
MissingFormLabel
- 27
Chaoui R, Heling K, Mielke G. et al .
Quality Standards of the DEGUM for Performance of Fetal Echocardiography.
Ultraschall in Med.
2008;
29
197-200
MissingFormLabel
- 28
Berg C, Geipel A, Gembruch U.
The four-chamber view in fetal echocardiography.
Ultraschall in Med.
2007;
28
132-151
MissingFormLabel
- 29
Yagel S, Arbel R, Anteby E Y. et al .
The three vessel and trachea view (3VT) in fetal cardiac scanning.
Ultrasound Obstet Gynecol.
2002;
20
340-345
MissingFormLabel
- 30
Bronshtein M, Zimmer E Z.
Sonographic diagnosis of fetal coarctation of the aorta at 14 – 16 weeks of gestation.
Ultrasound Obstet Gynecol.
1998;
11
254-257
MissingFormLabel
- 31
Sullivan I D.
Prenatal diagnosis of structural heart disease: does it make a difference to survival?.
Heart.
2002;
87
405-406
MissingFormLabel
- 32
Perolo A, Prandstraller D, Picchio F M. et al .
Outcome of fetuses with suspected aortic coarctation.
Ultrasound Obstet Gynecol.
2007;
30
367-455, OC 137
MissingFormLabel
Prof. R. Axt-Fliedner
OB & GYN, Helios-Klinikum Krefeld, Division of Prenatal Medicine
Lutherplatz 40
47805 Krefeld
Telefon: ++ 49/21 51 / 32 22 01
Fax: ++ 49/21 51 / 32 22 20
eMail: raxtfliedner@hotmail.com