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Outcome and Impact of Associated Left-Sided Cardiac Lesions in Coarctation of the Aorta Diagnosed During Fetal Life

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Stavros Polyviou, Marietta Charakida, Owen I. Miller, Thomas Witter RSCN, Trisha V. Vigneswaran, Vita Zidere, Thomas G. Day, David F.A. Lloyd, Gurleen K. Sharland, John M. Simpson

Original languageEnglish
Pages (from-to)114-121
Number of pages8
JournalAmerican Journal of Cardiology
Volume166
Early online date11 Feb 2022
DOIs
Accepted/In press2021
E-pub ahead of print11 Feb 2022
Published1 Mar 2022

Bibliographical note

Publisher Copyright: © 2021 Elsevier Inc.

King's Authors

Abstract

Significant effort has been put into the optimization of the antenatal diagnosis of coarctation of the aorta (CoA). However, although left-sided cardiac lesions are known to cluster, the necessity to intervene postnatally for other left-sided cardiac lesions has not been reported in a cohort of fetuses with suspected CoA. We report a study of all 89 fetuses with antenatally suspected and postnatally confirmed diagnosis of CoA who underwent CoA repair as the primary procedure at a single tertiary congenital heart disease center over 10 years (January 1, 2010, to December 31, 2019). Almost 1 in 5 patients (18%) had to undergo surgery and/or transcatheter intervention on additional left-sided cardiac lesions (14%) and/or reintervention on the aortic arch (12%) during follow-up to median age of 2.85 years. Freedom from intervention at 5 years was 78% (95% confidence interval [CI] 67 to 88%) if reintervention on CoA was excluded, and 72% (95% CI 60 to 82%) if this was included. Five-year survival was 95% (95% CI 90 to 100%). Furthermore, 20% of affected infants had genetic (10%) and/or extracardiac (16%) abnormalities. Our study highlights the need for comprehensive antenatal counseling, including the prognosis of primary repair of CoA and the potential development of additional left-sided cardiac lesions, which may be difficult to diagnose prenatally even in expert hands or impossible to diagnose because of the physiology of the fetal circulation.

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