Ostras O. Prenatal echocardiography as a method of early diagnosis and prediction of aortic coarctation in newborns

The disseration is devoted to improving the effeciency of prenatal echocardiography as a method of diagnosis of neonatal aortic coarctation (CoAo) through developing informative morphological, functional diagnostic criteria and its combinations and definition of optimal perinatal management. Echocardiography performed in 90 fetuses with suspicion of aortic coarctation, 68 of whom were born alive (researched group) and 60 fetuses and children with normal echocardiographic findings confirmed after birth (control group). Subgroup with CoAo confirmed after birth contains 54.4 % (25 of 46) newborns of high preoperative risk. The work developed and investigated new fetal echocardiographic predictors of neonatal CoAo - the angle between the isthmus and distal arch and the isthmus diastolic flow index the isthmic-ductal diastolic flow indexes difference. The angle between the isthmus and distal arch indicated the degree of its deformation and was independent of gestational age and was significantly higher compared with the control group (up to 32 weeks of gestation 143 ± 80 vs. 118 ± 100, p<0.0001; after 32 weeks of gestation 140 ± 90 vs. 116 ± 60, p<0.0001). The complex of direct morphological and functional predictors of CoAo characterized by greater diagnostic accuracy compared to complex of indirect predictors (p<0,05). It was showed a trend to increase the resistance of cerebral arteries in fetuses with CoAo compared with the control group and fetuses with false suspicion of CoAo (p<0.001). It was found that the most accurate fetal predictors of neonatal CoAo were Z score of aortic isthmus - an inverse correlation, sensitivity of 100 %, specificity of 84.9 %, and isthmic-ductal diastolic flow indexes difference - a direct correlation, sensitivity of 86.9 %, specificity of 96.5 %. Two-factor mathematical model that contains arguments of different physical nature for neonatal CoAo predicting in a fetus of geastational age from 18 to 40 weeks had been created. The sensitivity was 100 %, 95 % CI 94.1 - 100 %, specificity 95.4 %, 95 % CI 88.5 - 98.7 %, the percentage of correctly classified cases was 97.3 %. Differentiated perinatal management of newborns with prenatal suspicion of aortic coarctation had been developed and implemented. The 1st group of patients classified as fetuses with borderline mitral valve dimension included 11 (16.2 %) newborns who needed admission to intensive care unit during the first day after birth and cardiac surgery during the first five days after birth. Other 57 (83.8 %) patients classified as fetuses with mitral valve of normal dimension did not require admission to intensive care unit and cardiac interventions during the first five days after birth. As a result, the number of admissions in the first day after birth was decreased with a significant reduction of the actual length of their stay in the cardiac surgical intensive care unit (84.4 %) without any deterioration of the patients.