Prediction of coarctation of the aorta in fetuses with transposition of great arteries: Inverted ventricular discrepancy as a predictor of arch repair in TGA
Cosimo Marco Campanale, Patrizio Moras, Serena Ventrella, Marco Masci, Luciano Pasquini, Alessandra ToscanoAbstract
Introduction
Transposition of great arteries (TGA) with coarctation of the aorta (CoA) is a rare association but increases surgical complexity and worsens outcomes. Despite improvements in prenatal diagnosis, CoA remains difficult to diagnose before birth. Fetal ventricular discrepancy is a predictor of CoA in normal cardiac anatomy, and the smaller the mitral valve/ tricuspid valve (MV/TV) annulus diameters ratio, the higher the probability of CoA after birth. The aim of this study was to describe the features of MV/TV ratio in fetuses with TGA and CoA and to explore its predictive value for CoA and aortic arch repair at birth.
Material and Methods
This is a retrospective study at a tertiary center. We selected all cases of TGA from January 2011 to December 2024 excluding complex and/or associated anomalies. We reviewed all fetal echocardiograms available and, at the first diagnostic exam, we measured MV, TV, aortic valve (AV) and pulmonary valve (PV) annulus diameters, and MV/TV and AV/PV ratios were calculated. Transverse aortic arch, isthmus, descending aorta, and ductus arteriosus diameters were measured. We reviewed post‐natal diagnosis and surgical reports. Follow‐up was extended until the first year of age in terms of aortic re‐coarctation, late diagnosis of CoA and reoperations.
Results
We identified 188 TGA, among which 19 (10%) had CoA. TGA/VSD were 34 (18%) and TGA/IVS 154 (82%). Among the 136 prenatally diagnosed, 11 had CoA (8%). MV/TV ratio was higher in TGA/CoA group than in isolated TGA group ( p < 0.001) and AV/PV ratio was smaller in TGA/CoA compared to isolated TGA ( p < 0.001). ROC analysis was performed for the MV/TV ratio discriminating fetuses with TGA/CoA. A cut off value of 1 yielded a sensitivity of 100% and a specificity of 91.5% (AUC 0.99, p < 0.001).
Conclusions
We confirmed that the RV is smaller in TGA/CoA than in TGA alone; thus, the ventricular discrepancy is in favor of the LV. MV/TV ratio is a good predictor of CoA in fetuses with TGA, and a cutoff of 1 can be used to discriminate neonates at need for arch repair after birth.