Impact of antenatal echocardiography and prognostic factors for postoperative outcome in infants with aortic coarctation of the aorta

This study was to: 1) analyze impact of antenatal echocardiography, 2) assess pronostic factors of outcome, in neonates and infants with coarctation of aorta (COA).MethodsSingle-center analysis of clinical and echocardiographic data of fetus with suspicion of, and neonates and infants<1year of age with COA. Groups DAN (antenatal diagnosis) and DPN (postnatal diagnosis) were compared.Results286 cases were included, 106 in DAN group and 180 in DPN. Among 106 antenatal suspected COA, 11 were not confirmed after birth (sensitivity=34.5%). Antenatal ascending aorta diameter (AAO) and AO/PA ratio were predictors of postnatal COA. Heart failure (HF) was the main symptom in DPN group, absent in DAN (P<0.0001). Antenatal echocardiography was associated with lower diameter of isthmus (AOI), transverse arch (TrAO) and AAO. DPN had lower LV systolic fraction (LVSF) than DAN. Preoperative HF was associated with narrowest AOI, AAO, TrAO and decreased LVSF. PGE was administred in 53% preoperatively and mechanical ventilation in 39%. Among 275 confirmed COA (95 DAN and 180 DPN), 272 underwent Crafoord operation, at mean age 29days (median 12days) and mean time after admission 3.4days. Age at surgery was lower and time to surgery longer in DAN than DPN group. Residual postoperative aortic gradient was observed in 18 cases (6.7%), and spontaneously disappeared in the majority of them within 2 postoperative days. Median hospital stay was 11days. Survival was 98.5%. Restenosis occurred in 20 cases(7%), was related to postoperative AOI diameter and gradient, and AAO, and was more frequent in patients<1month at surgery (8.5%). Mortality was associated with Shone complex and parachute mitral valve (P<0.0001), LV diameters (P=0.02), ICU stay (P<0.0001), hospital stay (P=0.02).ConclusionAntenatal diagnosis impacts on early outcomes of neonates with COA. Postoperative isthmus diameter and gradient, and