Source:
An investigator from Boston Children’s Hospital (BCH), Boston, MA, conducted a retrospective review to evaluate reasons for referral for patients diagnosed with coarctation of the aorta (CoA). Study participants were patients who received a new diagnosis of CoA or interrupted aortic arch at BCH, or at another medical center and were referred to BCH for initial treatment. Participants were from 2 time periods: before (2006–2011) and after (2015–2019) the 2011 recommendation for routine pulse oximetry screening of newborns for critical congenital heart disease. The medical records of study patients were reviewed and demographic information and clinical data abstracted. Based on review of the clinical data, reasons for referral were classified and included fetal ultrasound finding suggestive of CoA, pulse oximetry screening, murmur, hypertension, decreased femoral pulse, arm-leg systolic blood pressure gradient, and as an incidental finding. Some participants had multiple findings at the time of referral. The age at diagnosis was documented and placed into categories. In addition to descriptive statistics, rates of diagnosis with fetal ultrasound in the earlier and later time periods were compared with a Fisher exact test.
Data on 400 patients, 200 from 2006–2011 and 200 during the 2015–2019 time periods, were analyzed. The age at diagnosis in the 2 groups were similar; 188 (47%) of study patients were diagnosed in the first 5 days of life, 73 (18.3%) between 6 days and 1 month, 37 (9.3%) between 1 month and 1 year of age, 63 (15.8%) between 1 and 9 years of age, 28 (7.0%) between 10 and 19 years old, and 11 (2.8%) as adults. A diagnosis was made by fetal ultrasound in 102 patients (25.5%) and was significantly more common among those diagnosed during the 2015–2019 time period than between 2006 and 2011 (30.5% and 20.5%, respectively; P = 0.03). During the later time period, of 47 patients ultimately diagnosed with CoA who had documentation of routine newborn pulse oximetry screening, only 8 (17%) “failed” the screening. A murmur prompted referral in 159 patients (39.8%), including some infants in whom the murmur was initially interpreted as peripheral pulmonic stenosis. Upper extremity hypertension was noted in 48 (12.0%) participants, all of whom were diagnosed when they were more than 1 month old. Decreased femoral pulse was detected in 56 patients (14.0%), and an arm-leg systolic blood pressure gradient was noted in 30 (7.5%). CoA was incidentally diagnosed in 30 participants (7.5%) while being evaluated for other conditions.
The author concludes that although CoA is frequently diagnosed by fetal ultrasound, and occasionally by routine newborn pulse oximetry screening, physical examination continues to play an important role in diagnosis.
Dr Spar has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
CoA, a narrowing of...
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