Fetal Echocardiography: Coarctation of the Aorta



coarctation of the aorta occurs in one in five thousand live births coarctation refers to narrowing of a segment of the aorta along the aortic arch the narrowing usually occurs near the origin the ductus arteriosus distal to the left subclavian artery a constriction can occur either producto or post ductal coarctation has been associated with additional cardiac defects including bicuspid aortic valve the aortic stenosis or insufficiency transposition of the great arteries contributor septal defects double outlet right ventricle and truncus arteriosus all coarctation of the aorta is suspected in utero by significant disproportion between the right and left atrium ventricular chambers a definitive diagnosis is not made until after delivery the ductus arteriosus has closed therefore in most cases the diagnosis must await neonatal confirmation using echocardiography this illustrates disproportion between the right and left atrial and ventricular chambers the right side larger than the left unless there is a significant ventricular septal defect almost all fetus is destined to develop coarctation will demonstrate disproportion as demonstrated in this image unfortunately there are other ideologies when disproportion of the chambers is observed that mimicked coarctation examples are placental dysfunction abnormal pulmonary venous return and pulmonary hypertension this clip illustrates the following enlargement of the right atrial and ventricular chambers decreased size of the left atrium and ventricle and a prominent foramen ovale within the left atrial chamber this illustrates three views that are useful in the prenatal diagnosis of coarctation of the aorta the four chamber view demonstrates right-to-left disproportion v mode measurements demonstrate the right ventricle to be one point nine five centimeters a left ventricle one point three five centimeters the trachea view demonstrates that ductus arteriosus to be dilated measuring 1.1 centimeters and the transversal regards to be decreased in size measuring 0.36 centimeters the aortic arch view demonstrates the area of the coarctation

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