Ultrasound-based incidence of coarctation of the aorta in true and false positive fetuses

To investigate the incidence and significant ultrasound parameter changes of coarctation of the aorta (CoA) among fetuses with suspected CoA, pregnant women with suspected CoA fetuses on prenatal ultrasound examination were prospectively enrolled. The CoA presence was confirmed after birth by computed tomographic angiography, ultrasound, surgery or autopsies. The ultrasound parameters were analyzed. Among 133 fetuses with suspected CoA, 44 (33.1%) pregnant women with CoA fetuses were confirmed after delivery with an age range 20-41 (31.36 ± 4.73) years and a gestational age range 20.5-36.5 (27.35 ± 4.52) weeks, and 89 (66.9%) pregnant women were confirmed to have false-positive CoA fetuses with matched (P > 0.05) age (range 21-44 and mean 30.96 ± 4.59 years) and gestational age (range 19.6-34.1 and mean 28.22 ± 3.28 weeks). Ductus arteriosus (DA) tortuosity was present in significantly (P < 0.05) more false-positive CoA fetuses (15 or 16.85%) than in true CoA fetuses (1 or 2.27%), whereas significantly more intracardiac malformation [25 (56.82%) vs. 31 (34.83%)] and ventricular septal defect [10 (22.73%) vs. 6 (6.74%)] took place in true CoA fetuses than in the counterparts. Significant (P < 0.05) independent risk factors for CoA presence were sagittal view isthmic Z-score (odds ratio or OR 3.62 and 95% confidence interval or CI 2.06-7.15), coarctation shelf (OR 17.71 and 95% CI 5.52-56.78), ascending aortic diameter (OR 109.67 and 95% CI 3.03-21068.82), and DA velocity time integral (VTI) (OR 24.98 and 95% CI 1.26-759.94). The cutoff value and AUC were 0.40 and 0.912, respectively, for the fitted model, -4.24 and 0.779 for isthmus Z-score, 0.35 and 0.685 for the ascending aorta diameter, and 13.78 and 0.623 for DA VTI. In conclusion, many ultrasound parameters are significantly different in CoA fetuses, and sagittal view isthmus Z-score, coarctation shelf, ascending aortic diameter, DA VTI may independently affect CoA presence.