Course and outcome of fetuses suspected of having coarctation of the aorta during gestation.
OBJECTIVE
To report the course and outcome of a group of fetuses with prenatal suspicion of coarctation of the aorta.


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 %).


CONCLUSIONS
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.
Axt-Fliedner
R
R
OB & GYN, Helios-Klinikum Krefeld, Division of Prenatal Medicine, Lutherplatz 40, 47805 Krefeld. raxtfliedner@hotmail.com
Hartge
D
D
Krapp
M
M
Berg
C
C
Geipel
A
A
Koester
S
S
Noack
F
F
Germer
U
U
Gembruch
U
U
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging / Q000235:genetics; D001017:Aortic Coarctation / Q000000981:diagnostic imaging* / Q000235:genetics / Q000401:mortality / Q000601:surgery; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000235:genetics / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000235:genetics / Q000401:mortality / Q000601:surgery; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000235:genetics / Q000601:surgery; D007621:Karyotyping; D008297:Male; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal