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Two- and three-dimensional imaging of coarctation shelf in the human fetus
  1. F S Molina,
  2. K H Nicolaides,
  3. J S Carvalho
  1. j.carvalho{at}rbht.nhs.uk

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Fetal diagnosis of coarctation of the aorta has high false-positive rates. Diagnosis has been based on indirect signs such as ventricular and arterial disproportion1 as the coarctation shelf is not easily identifiable prenatally.2 These images illustrate that direct imaging of the coarctation shelf in the fetus is possible.

Fetal echocardiography (FE) was performed at 20 weeks of gestation in a 35-year-old primigravida owed to ventricular disproportion. Right-to-left asymmetry was present at ventricular (mitral/tricuspid valves  =  3.6 mm/5.8 mm) and arterial level (aortic/pulmonary valves  =  2.3 mm/4.7 mm). Direct imaging of the aortic arch with power Doppler (3–5–7.5 MHz probe, SSD 5500-PHD, Aloka, Tokyo, Japan) showed a discrete posterior narrowing at the isthmus (panel A). At 36 weeks, three-dimensional FE was performed. Static three-dimensional volumes of the fetal heart with colour flow mapping were acquired (RAB 4–8 MHz probe, Voluson 730 Expert, GE Medical Systems, Milwaukee, WI, USA). Volumes were processed and rendered offline. A localised posterior aortic shelf was demonstrated within the aortic isthmus (panel B, video). The diagnosis was confirmed postnatally and end-to-end anastomosis carried out on the first day of life.

The site of coarctation is indicated by * in (A) and by an arrow in (B).

Acknowledgments

This article has been adapted from Molina F S, Nicolaides K H, Carvalho J S. Two- and three-dimensional imaging of coarctation shelf in the human fetus Heart 2008;94:584

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