Utility of prenatal ultrasound in diagnosis and prognosis of aortic arch obstruction: a 10-year single-center retrospective study.

OBJECTIVE

This study aimed to evaluate the prenatal echocardiographic features, diagnostic accuracy, associated anomalies, and early postnatal outcomes of fetal aortic arch obstruction, with particular emphasis on differentiating interrupted aortic arch from coarctation of the aorta.

METHODS

We conducted a retrospective analysis of 72 cases of aortic arch obstruction over a 10-year period, from 1 June 2014 to 1 June 2024, including interrupted aortic arch (IAA) and coarctation of the aorta (CoA). Prenatal ultrasound and medical records were used to summarize the characteristic ultrasound manifestations, genetic characteristics, and combined malformations, and to track perinatal and clinical outcomes, including postpartum echocardiography or CTA and other imaging examinations, surgical procedures, and prognosis.

RESULTS

A total of 72 fetal cases were retrospectively analyzed, including IAA types A, B, and C (22.22, 20.83, and 6.94%, respectively) and CoA (50.00%). The prenatal diagnostic accuracy was 90.28%. The IAA group had significantly smaller aortic valve annulus Z-scores, ascending aorta Z-scores, and aortic-to-pulmonary artery diameter ratios but significantly larger left-to-right ventricular (LV-to-RV) diameter ratios, ventricular septal defect-to-aortic diameter ratios, and ductus arteriosus Z-score compared to CoA (p < 0.05). Intracardiac malformations occurred in 88.89% of cases, with the prevalence of combined anomalies significantly higher in IAA (p < 0.001). Clinically, IAA cases showed more severe hypoxia and cyanosis and lower postoperative survival, whereas those with CoA cases had favorable outcomes.

CONCLUSION

Prenatal echocardiography is valuable not only for detecting fetal aortic arch obstruction but also for differentiating IAA from CoA and guiding perinatal risk stratification. IAA is associated with more complex intracardiac anomalies, greater ductal dependence, and poorer early outcomes, whereas CoA shows greater clinical heterogeneity and requires close postnatal surveillance.