Fetal Coarctation of the Aorta Successfully Repaired in the Neonatal Period a Case Report and Review of Literature

AbstractCoarctation of the aorta is one of the most difficult conditions to diagnose during fetal life witchaffecting with a frequency of approximately 5-8% of live births with congenital heart disease. Wewould like to report a case of coarctation of the aorta diagnosed prenatally at 28 weeks’ gestation. There were evidences of right ventricular and atrial enlargements, significant aortic stenosis ,antegrade and retrograde flow in proximal part of descending aorta at fetal echocardiography.Since it was not appropriate time for abortion, the pregnancy was monitored and continued totermination. Surgical relief of the aortic obstruction was done in the day 20 of birth. The neonatewas surgically treated successfully. Prenatal diagnosis of coarctation of the aorta is potentially lifesavingand can improve the outcomes of operative conditions in infants preparing for surgery.Early detection and surgically repair of Coarctation of the aorta can significantly improve survivalrate of affected neonates.Material and Method : Case presentation:A 34-year-old woman (gravida 1, Para 0,Abortus 0) known case of diabetic mellituswas referred for fetal echocardio graphicexamination at 28 weeks' gestational age dueto the routine medical assessments. Therewere not past medical history of anyunderling diseases such as hypertension.Family history of congenital heart diseasewas negative.There were right ventricular and atrialenlargements at fetal echocardiography (Figure1). Echocardiographic evidence ofsignificant aortic stenosis, antegrade andretrograde flow in proximal part ofdescending aorta (DAO) in aortic arch viewfetal echocardiography were seen (Figure 2and 3). There was CoA in suprasternal notchview in transthoracic echocardiography(figure 4). On color Doppler imaging, flowacceleration in stenotic portion of descendingaorta was noted (Figure 5). According to thefindings, the diagnosis of coarectation of theaorta was suggested for the fetus. Since it wasnot appropriate time for abortion, thepregnancy was monitored and continued totermination. After delivery, there werepathological cardiovascular findings of rightventricular(RV) failure. Doppler spectralechocardiography showed saw toothappearance (Figure 6). Computedtomography (CT) scan also revealed CoA inneonate (Figure 7).Surgical relief of the aortic obstruction wasdone in the day 20 of birth. No immediate complications were seem during surgicaloperation and the newborn was in stablecondition. Imaging of suprasternal view(posterior repair of coarctation) showed nosignificant narrowing of DAO in neonateafter surgery (Figure 8). After thepostoperative course, the newborn and thewoman were in good conditions. The patientis being regular follow up with pediatriccardiologist and is in good health Result: CoA is one of the most poorly detectedlesions at routine prenatal and postnatalscreening and is life threateningcardiovascular condition if undiagnosed inthe early neonatal period. The incidence ofCoA is approximately 4-5 per 100 live birthswith congenital heart defects (7,8). Diagnosis of CoA remains challenging. Prenatal diagnosis of CoA can be difficult tomake even in the best centers. Prenatal diagnosis of CoA isassociated with higher survival rate andbetter preoperative clinical outcome thanpostnatal diagnosis (11). In our case, thediagnosis of CoA was suggested according tothe dominance of right articular andventricular structures, significant aorticstenosis, flow acceleration in stenotic portionand antegrade and retrograde flow in proximal part of descending aorta in fetalimaging evaluations.Fetal CoA has no significant effect onintrauterine hemodynamics since the rightventricle via the ductus arteriosus mainlysupplies the descending aorta. In our newborncase, there were cardiovascular pathology ofheart RV failure including tachypnea,tachycardia, pallor, respiratory distress,grunting and feeding difficulties. Transthoracic echocardiography isthe most important diagnostic test forevaluation of both the anatomy and thehaemodynamic effects of CoA (16, 17).Surgical treatment of aortic coarctationallows to reach adult age and also improvesthe reproductive capacity of women (19). Patients with successfully treated coarctationoften continue to have systemic arterialhypertension both at rest and with exercisedespite the absence of any residualcoarctation due to various potentialmechanisms including resetting the reninangiotensinsystem (RAS), impaired smallresistance-vessel reactivity and abnormalaortic distensibility (20). Our case wassuccessfully treated surgically and at presentis at good condition and being regular followup.Conclusion: Our study showed that prenatal diagnosis of coarctation of the aorta is potentially lifesavingand can improve the outcome of operative conditions in infants preparing forsurgery. Early detection and surgically repair of CoA can significantly improve survivalrate of affected neonates.