Facts, Views & Vision
in ObGyn

Journal of the European Society for Gynaecological Endoscopy

esge_logo

Difficult prenatal diagnosis: fetal coarctation

A. Buyens1, W. Gyselaers1, A. Coumans2, S. Al Nasiry2, C. Willekes2, D. Boshoff3, J.-P. Frijns4, I. Witters1,2,3

1 Department of Obstetrics and Gynaecology, ZOL Hospitals Campus St Jan, Genk, Belgium.

2 Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands.

3 Department of Cardiology St-Jans Hospital Genk, Belgium. 4Center for Human Genetics, Catholic University of Leuven, Leuven, Belgium.

Keywords:

Prenatal diagnosis, coarctation, ventricular disproportion, isthmus/ductal ratio, discrepancy great vessels, isthmal z-scores, Doppler, flow disturbance, shelf.


Published online: Dec 27 2012

Abstract

The prenatal diagnosis of fetal coarctation is still challenging. It is mainly suspected by ventricular disproportion (smaller left ventricle than right ventricle). The sensitivity of ventricular discrepancy is however moderate for the diagnosis of coarctation and there is a high false positive rate. Prenatal diagnosis of coarctation is important because the delivery can be arranged in a centre with a pediatric cardiac intensive careand this reduces postnatal compli- cations and longterm morbidity.

For many years the prenatal diagnosis of coarctation has been investigated to improve specificity and sensitivity by several of measurements. This article reviews all relevant articles from 2000 until 2011 searching pubmed and the reference list of interesting articles. An overview of specific measurements and techniques that can improve the diagnosis of coarctation has been made, such as the isthmus diameter, ductal diameter, isthmus/ductal ratio, z-scores derived from measurements of the distal aortic isthmus and arterial duct, the presence of a shelf andisthmal flow disturbance. Also 3-dimensional (3D) and 4-dimensional (4D) imaging with or without STIC has been suggested to be used as newer techniques to improve diagnosis of coarctation in fetal life. Although more methods regarding prenatal diagnosis of coarctationare being investigated, the ultrasound specialist remains challenged to correctly diagnose this cardiac anomaly in prenatal life.