Aortic coarctation - difficulties of fetal diagnosis. Case report and literature review
S. Vlădăreanu, I. Petrescu, A. Dumitrescu, G. Iordache, M. Mitran
Rezumat: The aortic coarctation (CoA) is the most frequently
omitted ductal-dependent cardiac deffect on neonatal
screening and also one of the most difficult diagnosis to
establish before birth. It is estimated that 60-80% from the
newborns with isolated CoA are discharged at home from
neonatal departament as healthy babies, later developing
hemodynamic complications, that appear suddenly or
gradually as a consequence of closing the arterial ductus.
So, it is absolutely necessary to make the cardiac screening
for every newborn before discharging. It consists of preand
postductal pulsoximetry and measuring the blood
pressure to all four limbs. Also, it is necessary to confirm
this diagnosis by the fetal cardiologist in all cases of
CoA suspected and the pregnant women to be oriented
for delivery in a specialized centre in cardiac intensive
neonatal care. At fetal ultrasound, the suspicion of CoA is
increased by ventricular and large vessels disproportion
signs and in 4-chambers view and/or 3-vessels and
trachea especially in the first and second trimesters of
pregnancy. However, the prenatal screening registers a
high rate of fals-positive and false-negative results. The
prenatal diagnosis improves and reduces the morbidity
by allowing to plan the delivery in a tertiary center
and to establish the treatment with PGE to prevent the
constriction of arterial duct. We present the case of a term
newborn (38 weeks) born by caesarian section performed
in the Obstetrics and Ginecology Clinic of the “Elias”
Hospital, antenatal suspicioned with CoA, following two
ultrasounds performed at 34 and 35 weeks of gestation.
The newborn is treated with PGE medication from the first
hour of life. After two days of life, the pediatric cardiologist
excluded this diagnosis by echocardiography in “M.S.Curie” Hospital. The treatment with PGE was slowly
interrupted and the neonatal evolution was favorable. Cuvinte cheie: aortic coarctation, newborn,
permeable arterial duct, echocardiography,
aortic arch, prostaglandine.