Noninvasive diagnosis of aortic coarctation in neonates with patent ductus arteriosus.
OBJECTIVE
To find a noninvasive method to detect coarctation of the aorta (CoA) in the presence of a patent ductus arteriosus (PDA) in neonates.


METHODS
From 1994 to 1998, 36 neonates with CoA and PDA confirmed by surgery or cardiac catheterization were studied; another 19 neonates with isolated PDA served as control patients. The prospective study was conducted from 2001 to 2002 on 162 neonates.


RESULTS
Among the 36 neonates in the CoA group, 14 patients (39%) had blood pressure discrepancy, 26 patients (72%) had a visualized posterior shelf by echocardiogram, and the ratio of isthmus/descending aorta diameters (I/D ratio) was below 0.64 in 32 patients (89%). None of the control patients had these features. A diagnostic approach was subsequently proposed, according to which a neonate with PDA who fulfilled any of the above features was diagnosed as CoA plus PDA. In the prospective study, the sensitivity and positive predictive values of this method were both 91.7%, whereas the specificity and negative predictive values were both 99.3%.


CONCLUSIONS
Echocardiographic measurements of I/D ratio along with the delineation of posterior shelf and a BP discrepancy can satisfactorily identify CoA in the presence of PDA in neonates.
Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, National Taiwan University, No. 7 Chung-Shan South Road, 100 Taipei, Taiwan.
Chun-Wei
CW
Lu
Jou-Kou
JK
Wang
Chung-I
CI
Chang
Ming-Tai
MT
Lin
En-Ting
ET
Wu
Hung-Chi
HC
Lue
Yih-Sharng
YS
Chen
In-Su
IS
Chiu
Mei-Hwan
MH
Wu
D001011:Aorta / Q000002:abnormalities / Q000000981:diagnostic imaging; D001017:Aortic Coarctation / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D001783:Blood Flow Velocity; D001794:Blood Pressure; D016022:Case-Control Studies; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity