Diagnóstico ultrassonográfico pré-natal de coarctação de aorta: revisão sistemática e meta-análise

Abstract

Introduction: Coarctation of the aorta (CoAo) is the most common duct-dependent cardiac anomaly in neonates. Despite it, approximately 60 to 80% of cases are not diagnosed in the prenatal period. Objective: To identify prenatal ultrasound parameters associated with fetal CoAo. Methods: Systematic review and meta-analysis. This study was conducted according to PRISMA. We searched the databases: PubMed, Embase and Cochrane. The methodological quality of the included studies was evaluated using the NewCastle-Ottawa Scale (NOS). Meta-analyzes were performed in RevMan software. Results: Of the 188 articles identified in the databases, 9 were included in the study, representing a total of 530 fetuses, of which 219 had a confirmed CoAo diagnosis. Fetuses with CoAo presented mean Z-scores of mitral valve diameter lower than fetuses without CoAo (MD 1.21, 95% CI -1.71 and -0.77, P <0.00001), as well as aortic valve diameter (MD -1.09 , 95% CI -1.46 and -0.72, P <0.00001) and ascending aortic diameter (MD -0.98, 95% CI -1.70 and -0.27, P <0.00001). Mean Z-scores of pulmonary valve diameters were higher in fetuses without CoAo (MD 0.69, 95% CI 0.19 and 1.18, P = 0.006). Regarding the ratio between pulmonary artery diameter and ascending aorta, we observed higher mean values in fetuses without CoAo when compared to fetuses with CoAo (MD 0.33, 95% CI 1.01 and 0.65, P = 0.04). The mean Z-scores of aortic isthmus diameters were lower in fetuses with CoAo, both in the sagittal view (MD -1.12, 95% CI -1.79 and -0.45, P = 0.001), and in 3-vessel view (MD -1.41, IC 95% -2.08 and -0.74, P <0.0001). Patients with CoAo presented higher values of the ratio between the areas (MD 0.31, CI 95% 0.05 and 0.57, P = 0.02) and diameters (MD 0.21, 95% CI 0.04 and 0.39 , P = 0.02) of the right and left ventricles, indicating greater ventricular disproportion when compared to patients without CoAo. Conclusion: Several fetal ultrasonographic parameters differ significantly between fetuses with and without CoAo. New imaging studies involving larger populations are needed to obtain conclusive results and elaborate predictive models.