OC12.06: Outcome of Prenatal Ventricular Size Discrepancy in Cases Without Coarctation

Fetal left/right ventricular size discrepancy is the most important predictor of coarctation (CoA). These cases are, however, diagnosed with CoA in about 50%. This study describes the long-term outcome of these fetuses without CoA. Cases with prenatal left-right discrepancy were extracted from a large previously described regional cohort (PMID 2562530). Prospectively collected cases from one center (2012–2014) were added. Cases with prenatal extracardiac malformations or aneuploidy were excluded. Based on postnatal diagnosis, the cases were divided in CoA or non-CoA. Follow-up data were retrieved until March 2015 (co-morbidity, possible cause for prenatal discrepancy). Of 70 fetuses with prenatal left/right discrepancy, 12 cases were excluded due to prenatal extracardiac anomalies. After birth CoA was confirmed in 32 of 58 (55%). 26 cases had normal aortic arch after duct closure. In CoA group, 4 (18.2%) did not need intervention, 1 had balloon dilatation (4,5%), 17 (77,2%) had surgical CoA repair. No mortality occurred. In 26 non-CoA cases, 1 was lost to follow-up, 2 were discharged without follow-up after normal echocardiography on neonatal ward. 9 cases (35%) had prenatal findings that explain the asymmetry but do not rule out CoA (4 restrictive foramen ovale, 2 small VSD, 3 LSVC). Mean follow-up was 2,9 years. About 42% (11) showed morbidity (PPHN, ASD type II, bicuspid aortic valve, thickened interventricular septum with endocardial fibroelastosis, postnatal chromosomal abnormalities, sagittal sinus and renal vein thrombosis, pulmonary sequestration). Although CoA is not confirmed in 50% of neonates with fetal left/right asymmetry, proper postnatal monitoring is warranted, as the occurrence of other morbidity with long-term consequences, is considerably high. The occurrence of additional morbidity should be incorporated in prenatal counselling.