Babies could now be more accurately diagnosed with a common form of congenital heart disease before birth, thanks to research supported by our NIHR Clinical Research Facility and funded by our NIHR Guy’s and St Thomas’ Biomedical Research Centre.
The study looked at the use of 3D fetal cardiac MRI and flow measurements to predict neonatal coarctation of the aorta in a landmark study. The new imaging techniques were developed at Evelina London Children’s Hospital, in collaboration with King’s College London. The research found that 3D fetal MRI could be much more accurate in predicting coarctation, and this could help with planning delivery of care for in pregnancies where the baby may be affected by condition.
Neonatal coarcation of the aorta is a condition where the aorta – the main artery in the body – becomes severely narrowed in the first few days of life. Affected babies can become unwell very quickly and need urgent medical care, followed by heart surgery to repair the narrowing. However, because coarcation only develops after birth, it can be difficult to predict from prenatal ultrasound scans alone, and up to half of all babies suspected to have the condition before birth do not ultimately need surgery. These babies still face a prolonged period of separation in hospital as they are assessed and monitored before they can go home with their families.
Dr David Lloyd, who was first author on the paper, said: “Our study found combining 3D MRI images and flow measurements in the fetal heart could predict neonatal coarctation with over 90% accuracy, potentially helping to remove much of the uncertainty around the condition for both families and the doctors caring for them. These new techniques are now being used prospectively in women carrying a baby with suspected coarctation at the Evelina London Children’s Hospital, and will soon form the basis for a new multi-site collaboration, using both ultrasound and MRI, between Guy’s and St Thomas’, King’s College Hospital and the Royal Brompton Hospital.”
An example of the 3D fetal heart imaging in the study, in two babies suspected to have coarctation of the aorta before birth. New 3D MRI methods have made it possible to detect subtle differences between true cases of coarcation needing postnatal surgery (blue heart, panels C and D) and those with a similar appearance where the baby did not develop coarcation after birth (red heart, panels A and B).