Ultrasound Obstet Gynecol. 2022 Feb 3. doi: 10.1002/uog.24873. Online ahead of print.
ABSTRACT
INTRODUCTION: Outcomes of common arterial trunk (CAT) depend mainly on truncal valve function, coronary artery abnormalities and presence of interrupted aortic arch. The objective of this study was to evaluate the accuracy of prenatal diagnosis in CAT by analyzing: (1) anatomic subtypes, (2) truncal valve function and (3) the potential impact of prenatal CAT diagnosis on postnatal mortality and morbidity in the current era.
METHODS: Retrospective analysis of all prenatally diagnosed CAT patients with postnatal or fetopsy confirmation from 2011- 2019 in a single tertiary center. Cohen’s Kappa statistic was used to measure agreement for pre- and postnatal assessment of anatomic subtypes according to Van Praagh and of truncal valve function. Mortality and morbidity variables were compared.
RESULTS: 84 patients (62 live born with prenatal diagnosis/16 live born with postnatal diagnosis/ 6 terminations of pregnancy with fetopsy) met inclusion criteria. Diagnostic accuracy for prenatal diagnosis of CAT anatomic subtypes was 80.3%. However pre-and postnatal concordance for subtype diagnosis was only moderate (Kappa κ= 0.43) since no fetus had a prenatal diagnosis of CAT type A3, and only half of patients with CAT type A4 (8/17) were diagnosed prenatally. Fetal evaluation of truncal valve function underestimated the presence and severity of insufficiency (slight agreement; κ=0.19). However, 4 of 5 postnatally confirmed significant stenoses were diagnosed prenatally (moderate agreement; κ=0.38). Postoperative mortality was comparable in patients with or without prenatal diagnosis (p=0.87). CAT patients with fetal diagnosis underwent earlier intervention (p<0.001), had shorter intubation time (p=0.047) and shorter global hospital stay (p=0.01).
CONCLUSION: Prenatal accuracy of CAT diagnosis remains insufficient to tailor neonatal management and to predict outcomes. Fetal assessment of truncal valve dysfunction appears unreliable due to perinatal transition changes. Progress should be made to improve fetal diagnosis of anatomic subtypes requiring postnatal prostaglandin infusion. This article is protected by copyright. All rights reserved.
PMID:35118719 | DOI:10.1002/uog.24873
