Echocardiographic diagnosis of Neonatal Coarctation of the Aorta
Research type
Research Study
Full title
Echocardiographic Diagnosis of Prenatally suspected Neonatal Coarctation of the Aorta: Can we improve accuracy?
IRAS ID
292430
Contact name
Malenka Bissell
Contact email
Sponsor organisation
University of Leeds
Duration of Study in the UK
1 years, 4 months, 1 days
Research summary
Coarctation of the aorta (CoA) is a common congenital heart defect. It is a narrowing of the main body blood vessel causing less blood flow to the body. New-borns with this condition can be very ill and potentially die; once identified it can be treated with surgery. As such, diagnosis before or shortly after birth is very important to avoid the new-born baby becoming unwell, but detection can be difficult due to an additional heart vessel which every fetus has and which slowly close when the baby is born as they are no longer needed. CoA can only be diagnosed for certain after this extra vessel (the duct) has closed. Ultrasound of the heart (echocardiogram) is used for diagnosis. As it is so important not to miss any cases, doctors err on the side of caution and therefore and raise the suspicion of CoA before and shortly after delivery in about 50% more cases than ultimately get diagnosed with CoA. All babies with a suspicion of the diagnosis CoA remain on the neonatal intensive care unit for around 5-7 days and undergo potentially unnecessary management such as intravenous fluids and medications, vascular access, and multiple echocardiograms until the diagnosis is either confirmed or excluded (once the duct has closed). This also causes disruption to early family life due to admission to the neonatal intensive care unit, delay in establishing feeding and extended hospital admission.
A review of the literature reveals that combining several echocardiogram measurements can improve diagnostic accuracy by excluding CoA before the duct is closed. Therefore, these babies, where the diagnosis has been excluded can then be reunited with their mothers earlier.
We will use fetal cardiac clinic records to identify patients with antenatally suspected CoA, born at Leeds Teaching Hospitals or receiving care at Leeds Teaching Hospitals within the first 3 months of life, from 2015 onwards. Postnatal echocardiogram images collected as part of routine patient care will be reviewed and measurements made of key anatomical points of the aorta and other vessels. These measures will then be anonymised and analysed in relation to the patient outcomes to see if they can be used to more accurately categorise patients according to risk.REC name
Wales REC 6
REC reference
21/WA/0154
Date of REC Opinion
10 May 2021
REC opinion
Favourable Opinion