Vol.48 - Número 2, Abril/Junio 2019 Imprimir sólo la columna central

Coarctation of the aorta in fetus

CARLOS GARCÍA GUEVARA1, JUAN HJALMAR CORRALES ABARCA2,
YALILI HERNÁNDEZ MARTÍNEZ3
1- Cardiocentro Pediátrico William Soler. La Habana, Cuba.
2- Centro Especializado Fetal Scan Arequipa, Perú.
3- Policlínico Docente Felo Echezarreta. Red Cardiopediátrica Nacional. Mayabeque, Cuba.
Boyeros (10800). La Habana, Cuba
E-mail
Recibido 07-FEB-2019 – ACEPTADO después de revisión 21-FEB-2019.
There are no conflicts of interest to disclose.

 

Pregnant primiparous woman with a 24-week gestation, with no obstetric risk, referred to the national reference center for the diagnosis of congenital heart diseases (Cardiocentro Pediátrico William Soler) due to suspicion of structural alteration of the heart (aortic stenosis). Fetal echocardiogram was conducted on the pregnant woman, and right chamber and pulmonary artery dilatation, and ductus arteriosus are detected (Figure 1), as well as the presence of ventricular septal defect. When visualizing the longitudinal view of the aortic arch, a narrowing was observed at the level of the aortic isthmus, with turbulent flow when using color Doppler echocardiography superimposed on the 2-dimensional image (Figure 2); an image that led us to consider the presence of coarctation of the aorta. Once the infant was born, the mentioned pathology was verified, and the infant was operated with excellent results; but at 8 months the presence of subaortic stenosis was detected by muscle spur, requiring a new surgery. As a complication, complete atrioventricular block arose, this time requiring pacemaker implant.

Figure 1


Figure 2

 

During fetal life, coarctation of the aorta is very difficult to diagnose, as shown by the number of false positive and false negative cases reported in the best centers, and the scant number of cases reported in the reviewed literature [1]. The suspicion of this entity is established when there is disproportion in the size of the ventricles (right ventricle larger than the left ventricle), but such size discrepancy only displays a moderate sensitivity and a low specificity, as well as a low predictive value for its diagnosis [2-4]. Other measurements such as aortic isthmus diameter, isthmus/ductus arteriosus ratio, and the presence of turbulence and/or reverse flow in the isthmus area, could be significant tools in the diagnosis of this disease [5].

 

BIBLIOGRAPHY

  1. Stos B, Le Bidois J, Fermont L, Bonnet D. Is antenatal diagnosis of coarctation of the aorta possible? Arch Mail Coeur Vaiss. 2007; 100: 428-32.
  2. Matsui H, Mellander M, Roughton M, et al. Morphological and Physiological Predictor of Fetal Aortic Coarctation. Circulation. 2008; 118: 1793-1801.
  3. Allan L. Fetal Echocardiography. A practical guide. Cambridge University Press. UK; 2009.
  4. Buyens A, Gyselaers W, Coumans A, et al Difficult prenatal diagnosis: fetal coarctation. Facts Views Obgyn. 2012; 4 (4): 230-36.
  5. Kailin JA, Santos AB, Yilmaz Furtun B, et al. Isolated coarctation of the aorta in the fetus: A diagnostic challenge. Echocardiography 2017; 34 (12): 1768-75.

Publication: June 2019



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