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Measurement of the Great Vessels in the Mediastinum Could Help Distinguish True From False-Positive Coarctation of the Aorta in the Third Trimester

Departments of Diagnosis and Prevention of Fetal Malformations (M.S., K.J., M.R.-L.) and Pediatric Cardiology (T.M.), Medical University of Lodz, and Research Institute, Polish Mother’s Memorial Hospital, Lodz, Poland; and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania USA (J.R.).

Address correspondence to Maria Respondek-Liberska MD, PhD, Department of Diagnosis and Prevention of Congenital Malformations, Polish Mother’s Memorial Hospital, Ulica Rzgowska 281/289, 93-345 Lodz, Poland. E-mail: majkares{at}uni.lodz.pl

Objective. We investigated the utility of analyzing prenatal mediastinal measures of the great arteries in distinguishing true coarctation of the aorta (CoA) from false-positive CoA. Methods. All fetuses in this study had suspicion of CoA based on the presence of right-left heart disproportion. We defined 3 study groups: group 1, true fetal CoA; group 2, false-positive fetal CoA with a narrow aortic arch; and group 3, false-positive fetal CoA without a narrow aortic arch. Results. In group 1, the mean mediastinal pulmonary artery (PA) to ascending aorta (Ao) diameter ratio ± SD was 2.03 ± 0.48, and in group 2, the ratio was 1.60 ± 0.23. The difference was statistically significant (P = .0018, t test). In group 3, the mean PA:Ao ratio was 1.35 ± 0.14. The difference between groups 1 and 3 was statistically significant (P = .0002, t test). In our study group, for a PA:Ao ratio of 1.60, sensitivity was 83.0%; specificity, 85.0%; positive predictive value, 62.5%; and negative predictive value, 94.0%. Conclusions. In the third trimester, the main PA:Ao ratio as measured in the fetal mediastinum can be a helpful tool in distinguishing true CoA requiring neonatal cardiac surgery from false-positive CoA and simple disproportion requiring medical attention but no surgery in the first month of postnatal life.

Key Words: coarctation of the aorta • great vessels • mediastinum • third trimester

Abbreviations: Ao, ascending aorta • CoA, coarctation of the aorta • PA, pulmonary artery

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