Factores predictivos anatómicos y funcionales en le diagnóstico prenatal de la coartación de aorta

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Pediatría. Fecha de lectura: 22-01-2016Esta tesis tiene embargado el acceso al texto completo hasta el 22-07-201

Factores predictivos anatómicos y funcionales en el diagnóstico prenatal de la coartación de aorta

Tesis doctoral inédita, leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Pediatría. Fecha de lectura: 22 de enero de 201

Anillo vascular. Diagnóstico por ecocardiografía en periodo fetal

Congenital anomalies of the aortic arch and its branches may cause compression of the esophagus and trachea and be responsible of secondary compressive symptoms but frequently have an asymptomatic course. Advances in fetal echocardiography and the three vessel and trachea view (3VT) with a proper visualization of upper mediastinumallows accurate diagnosis of vascular rings. Detection of these abnormalities requires to rule out further congenital malformations and to detect genetic anomalies. Prenatal diagnosis contributes to detect postnatal asymptomatic cases and its systematic prenatal detection would allow estimating a real prevalence of vascular rings in the general population.Las alteraciones congénitas del arco aórtico, especialmente los anillos vasculares, pueden producir compresión de la tráquea y del esófago y originar síntomas secundarios aunque en muchas ocasiones son asintomáticos. El avance de la ecocardiografía prenatal, y especialmente la visualización del mediastino superior fetal con el plano tres vasos-tráquea (3VT), permite un diagnóstico preciso de los anillos vasculares en la vida fetal. La detección de estas anomalías obliga a descartar otras malformaciones fetales y anomalías genéticas. Su detección prenatal contribuye a detectar casos asintomáticos y su búsqueda sistemática permitiría una estimación de la prevalencia real en la población

Diagnostic accuracy of prenatal ultrasound in coarctation of aorta: systematic review and individual participant data meta‐analysis

Objective: To determine the diagnostic accuracy of prenatal ultrasound in detecting coarctation of the aorta (CoA). Methods: An individual participant data meta-analysis was performed to report on the strength of association and diagnostic accuracy of different ultrasound signs in detecting CoA prenatally. MEDLINE, EMBASE and CINAHL were searched for studies published between January 2000 and November 2021. Inclusion criteria were fetuses with suspected isolated CoA, defined as ventricular and/or great vessel disproportion with right dominance on ultrasound assessment. Individual participant-level data were obtained by two leading teams. PRISMA-IPD and PRISMA-DTA guidelines were used for extracting data, and the QUADAS-2 tool was used for assessing quality and applicability. The reference standard was CoA, defined as narrowing of the aortic arch, diagnosed after birth. The most commonly evaluated parameters on ultrasound, both in B-mode and on Doppler, constituted the index test. Summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and likelihood ratios were computed using the hierarchical summary receiver-operating-characteristics model. Results: The initial search yielded 72 studies, of which 25 met the inclusion criteria. Seventeen studies (640 fetuses) were included. On random-effects logistic regression analysis, tricuspid valve/mitral valve diameter ratio > 1.4 and > 1.6, aortic isthmus/arterial duct diameter ratio 1.4 (P = 0.048) and bidirectional flow at the foramen ovale (P = 0.012) were independently associated with CoA. Redundant foramen ovale was inversely associated with CoA (P = 0.037). Regarding diagnostic accuracy, tricuspid valve/mitral valve diameter ratio > 1.4 had a sensitivity of 72.6% (95% CI, 48.2-88.3%), specificity of 65.4% (95% CI, 46.9-80.2%) and DOR of 5.02 (95% CI, 1.82-13.9). The sensitivity and specificity values were, respectively, 75.0% (95% CI, 61.1-86.0%) and 39.7% (95% CI, 27.0-53.4%) for pulmonary artery/ascending aorta diameter ratio > 1.4, 47.8% (95% CI, 14.6-83.0%) and 87.6% (95% CI, 27.3-99.3%) for aortic isthmus diameter Z-score of < -2 in the sagittal view and 74.1% (95% CI, 58.0-85.6%) and 62.0% (95% CI, 41.6-78.9%) for aortic isthmus diameter Z-score of < -2 in the three-vessel-and-trachea view. Hypoplastic aortic arch had a sensitivity of 70.0% (95% CI, 42.0-88.6%), specificity of 91.3% (95% CI, 78.6-96.8%) and DOR of 24.9 (95% CI, 6.18-100). The diagnostic yield of prenatal ultrasound in detecting CoA did not change significantly when considering multiple categorical parameters. Five of the 11 evaluated continuous parameters were independently associated with CoA (all P < 0.001) but all had low-to-moderate diagnostic yield. Conclusions: Several prenatal ultrasound parameters are associated with an increased risk for postnatal CoA. However, diagnostic accuracy is only moderate, even when combinations of parameters are considered. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.Depto. de MedicinaDepto. de Salud Pública y Materno - InfantilFac. de MedicinaTRUEpubAPC financiada por la UC