title: Prenatal Sonographic Predictors of Neonatal Coarctation of the Aorta.
abstract: OBJECTIVE
  To identify practical prenatal sonographic markers for the postnatal diagnosis of coarctation of the aorta.
  
  
  METHODS
  We reviewed the fetal echocardiograms and postnatal outcomes of fetal cases of suspected coarctation of the aorta seen at a single institution between 2010 and 2014. True- and false-positive cases were compared. Logistic regression analysis was used to determine echocardiographic predictors of coarctation of the aorta. Optimal cutoffs for these markers and a multivariable threshold scoring system were derived to discriminate fetuses with coarctation of the aorta from those without coarctation of the aorta.
  
  
  RESULTS
  Among 35 patients with prenatal suspicion of coarctation of the aorta, the diagnosis was confirmed postnatally in 9 neonates (25.7% true-positive rate). Significant predictors identified from multivariate analysis were as follows: Z score for the ascending aorta diameter of -2 or less (P = < .001), Z score for the mitral valve annulus of -2 or less (P= .033), Zscore for the transverse aortic arch diameter of -2 or less (P= .028), and abnormal aortic valve morphologic features (P= .026). Among all variables studied, the ascending aortic Z score had the highest sensitivity (78%) and specificity (92%) for detection of coarctation of the aorta. A multivariable threshold scoring system identified fetuses with coarctation of the aorta with still greater sensitivity (89%) and only mildly decreased specificity (88%).
  
  
  CONCLUSIONS
  The finding of a diminutive ascending aorta represents a powerful and practical prenatal predictor of neonatal coarctation of the aorta. A multivariable scoring system, including dimensions of the ascending and transverse aortas, mitral valve annulus, and morphologic features of the aortic valve, provides excellent sensitivity and specificity. The use of these practical sonographic markers may improve prenatal detection of coarctation of the aorta.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal-Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand asanitra@hotmail.com.
authors.forename: Sanitra
authors.initials: S
authors.lastname: Anuwutnavin
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Satou
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Los Angeles, California USA.
authors.forename: Ruey-Kang
authors.initials: RK
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California USA.
authors.forename: Greggory R
authors.initials: GR
authors.lastname: DeVore
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Abuel
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Sklansky
mesh_terms: D001011:Aorta / Q000000981:diagnostic imaging / Q000196:embryology; D001017:Aortic Coarctation / Q000000981:diagnostic imaging* / Q000196:embryology; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011237:Predictive Value of Tests; D011247:Pregnancy; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: coarctation of the aorta; fetal echocardiography; prediction; prenatal diagnosis; sonographic indicators