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@article{1086487,
author = {Jowett, V. and Aparicio, P. and Santhakumaran, S. and Seale, A. and Jičínská, Hana and Gardiner, H. M.},
article_location = {Spojené státy americké},
article_number = {1},
doi = {http://dx.doi.org/10.1002/uog.11161},
keywords = {aortic coarctation; coarctation shelf; fetus; surgery},
language = {eng},
issn = {0960-7692},
journal = {Ultrasound in Obstetrics & Gynecology},
title = {Sonographic predictors of surgery in fetal coarctation of the aorta},
volume = {40},
year = {2012}
}
TY - JOUR
ID - 1086487
AU - Jowett, V. - Aparicio, P. - Santhakumaran, S. - Seale, A. - Jičínská, Hana - Gardiner, H. M.
PY - 2012
TI - Sonographic predictors of surgery in fetal coarctation of the aorta
JF - Ultrasound in Obstetrics & Gynecology
VL - 40
IS - 1
SP - 47-54
EP - 47-54
PB - WILEY-BLACKWELL
SN - 09607692
KW - aortic coarctation
KW - coarctation shelf
KW - fetus
KW - surgery
N2 - Objectives Isolated fetal coarctation of the aorta (CoA) has high false-positive diagnostic rates by cardiologists in tertiary centers. Isthmal diameter Z-scores (I), ratio of isthmus to duct diameters (I:D), and visualization of CoA shelf (Shelf) and isthmal flow disturbance (Flow) distinguish hypoplastic from normal aortic arches in retrospective studies, but their ability to predict a need for perinatal surgery is unknown. The aim of this study was to determine whether these four sonographic features could differentiate prenatally cases which would require neonatal surgery in a prospective cohort diagnosed with CoA by a cardiologist. Methods From 83 referrals with cardiac disproportion (January 2006 to August 2010), we identified 37 consecutive fetuses diagnosed with CoA. Measurements of I and I:D were made and the presence of Shelf or Flow recorded. Sensitivity, specificity and areas under receiveroperating characteristics curves, using previously reported limits of I < - 2 and I:D < 0.74, as well as Shelf and Flow were compared at first and final scan. Associations between surgery and predictors were compared using multivariable logistic regression and changes in measurements using ANCOVA. Results Among the 37 fetuses, 30 (81.1%) required surgery and two with an initial diagnosis of CoA were revised to normal following isthmal growth, giving an 86% diagnostic accuracy at term. The median age at first scan was 22.4 (range. 16.67.0) weeks and the median number of scans per fetus was three (range, one to five). I < - 2 at final scan was the most powerful predictor (odds ratio, 3.6 (95% CI, 0.4727.3)). Shelf was identified in 66% and Flow in 50% of fetuses with CoA. Conclusion Incorporation of these four sonographic parameters in the assessment of fetuses with suspected CoA at a tertiary center resulted in better diagnostic precision regarding which cases would require neonatal surgery than has been reported previously.
ER -
JOWETT, V., P. APARICIO, S. SANTHAKUMARAN, A. SEALE, Hana JIČÍNSKÁ a H. M. GARDINER. Sonographic predictors of surgery in fetal coarctation of the aorta. \textit{Ultrasound in Obstetrics \&{} Gynecology}. Spojené státy americké: WILEY-BLACKWELL, 2012, roč.~40, č.~1, s.~47-54. ISSN~0960-7692. Dostupné z: https://dx.doi.org/10.1002/uog.11161.
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