The role of CT angiography in preoperative evaluation of aortic coarctation

Year 2020, Volume: 37 Issue: 3, 73 - 79, 30.04.2020

Tülay Demircan , Onur Işık Muhammet Akyüz Ahmet Çapar Kayı Eliaçık

Abstract

Aortic coarctation (CoA) constitutes 5-8% of all congenital heart diseases. Physical examination findings and imaging methods are helpful in diagnosis. Computed tomographic (CT) angiography and transthoracic echocardiography are the common diagnostic tools for aortic coarctation. In this study, we aimed to evaluate the intracardiac and extracardiac anomalies that we detected in our cases. We also evaluated the contribution of preoperative diagnosis of extracardiac anomalies in preventing surgical complications. From January 2016 and May 2018, we enrolled 37 infants with clinically suspected CoA who underwent CT angiography and transthoracic echocardiography and operated in our hospital. The extracardiac and intracardiac anomalies associated with CoA were evaluated. Extracardiac anomalies that were not seen in transthoracic echocardiography but diagnosed by CT angiography were evaluated. The contribution of CT angiography in surgical planning was determined. The patients (24 males and 13 females) were aged from one day to 240 months. Of this sample, 54% of thirty-seven patients were in the neonatal period. When we examined the accompanying intracardiac pathologies, ventricular septal defect was present in three cases, atrial septal defect in seven cases, subaortic membrane and Shone complex in two cases. Extracardiac anomalies such as, tracheal duplication, Scimitar syndrome, pulmonary vein course anomaly and left bronchial pressure were detected by CT angiography in 2.7% of the patients. Abnormal right subclavian artery was present in 10.8% of the cases and the surgical team was more sensitive to paraplegia measures. In 19% of the longsegment coarctation; if the surgical team consider it too far for end- to-end anastomosis, they chose synthetic tube graft for the patient prior to the operation. The results indicated that the CT angiography is a beneficial non-invasive method for confirming CoA and detecting the accompanying extracardiac anomalies in children with CoA. Preoperative morphological features and extracardiac anomalies which were detected by CT angiography were found to be reliable for surgical planning.

Keywords

Coarctation of the aorta, extracardiac anomalies, imaging methods, transthoracic echocardiography

References

• Referans1. Park, M.K., 2002. Coarctation of the Aorta. In: Park MK (ed). Pediatric Cardiology for Practitioners. 4th ed. St Louis, Missouri, Mosby, pp. 165-173.
• Referans2. Ringel, R.E., Gauvreau, K., Moses, H., Jenkins, K.J., 2012. Coarctation of the Aorta Stent Trial (COAST): study design and rationale. Am. Heart. J. 164: 7-13.
• Referans3. Beekman, R.H., 2013. Coarctation of th aorta. In: Allen, H.D., Driscoll, D.J., Shaddy, R.E., Feltes, T.F., eds. Moss and Adams’ Heart Disease in Infants, Children, and Adolescents. 8th ed. Philadelphia, P.A.,Wolters Kluwer Health, pp. 1044-1060.
• Referans4. Brickner, M.E., Hillis, L.D., Lange, R.A., 2000. Congenital heart disease in adults: first of two parts. N. Engl. J. Med. 342,256-263.
• Referans5. Attenhofer Jost, C.H., Schaff, H.V., Connolly, H.M., Danielson, G.K., Dearani, J.A., Puga, F.J.,Warnes, C.A., 2002. Spectrum of reoperations after repair of aortic coarctation: importance of an individualized approach because of coexistent cardiovascular disease. Mayo Clin. Proc. 77, 646-653.
• Referans6. Mellander, M., Sunnegardh, J., 2006. Failure to diagnose critical heart malformation in newborns before discharge: an increasing problem? Acta Paediatr. 95, 407-413.
• Referans7. Gómez-Montes, E., Herraiz, I., Mendoza, A., Escribano, D., Galindo, A., 2013. Prediction of coarctation of the aorta in the second half of pregnancy. Ultrasound Obstet. Gynecol. 41,298-305.
• Referans8. Lee, E.Y., Siegel, M.J., Hildebolt, C.F., Gutierrez, F.R., Bhalla, S., Fallah, J.H., 2004. MDCT evaluation of thoracic aortic anomalies in pediatric patients and young adults. Comparison of axial, multiplanar and 3D images. A.J.R.182,777-84.
• Referans9. Tsai, I.C., Chen, M.C., Jan, S.L., Wang, C.C., Fu, Y.C., Lin, P.C., Lee ,T., 2008. Neonatal cardiac multidetector row CT: why and how we do it. Pediatr. Radiol. 38,438-451.
• Referans10. Taylor, A.M., 2008. Cardiac imaging: MR or CT? Which to use when. Pediatr. Radiol. 38(3), 433-438.
• Referans11. Frush ,D.P., Herlong, J.R., 2005. Pediatric thoracic CT angiography. Pediatr. Radiol. 35,11-25.
• Referans12.Evangelista , A., Flachskampf, F., Lancellotti P., Badano, L., Aguilar, R., Monaghan, M., Zamorano, J., Nihoyannopoulos, P., 2008.European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur. J. Echocardiogr. 9(4),438-48.
• Referans13. Al-Azzazy M.Z., Nasr, M.S., Shoura, M.A., 2014. Multidetector computed tomography (MDCT) angiography of thoracic aortic coarctation in pediatric patients: pre operative evaluation Egypt J. Radiol. Nucl. Med. 45,159-167.
• Referans14. Rose-Felker, K., Robinson, J., Backer, C., Cynthia, K.R., Osama M. E.,Michael, C.M.,Karen, R., Christina L. S, Jeffrey ,G. G., 2017. Preoperative Use of CT Angiography in Infants With Coarctation of the Aorta. World Journal for Pediatric and Congenital Heart Surgery. 8(2), 196-202.
• Referans15. Turkvatan, A., Ozdemir, P.A., Olcer, T., Cumhur ,T.,2009. Coarctation of the aorta in adults: preoperative evaluation with multidetector CT angiography. Diagn. Interv. Radiol. 15(4),269-74.
• Referans16. Didier, D., Saint-Martin, C., Lapierre, C., Trindade, P.T., Lahlaidi, N., Vallee, J.P., 2006. Coarctation of theaorta: pre and postoperative evaluation with MRI and MR angiography;correlation with echocardiography and surgery. Int. J. Cardiovasc. Imaging.22, 457-475.
• Referans17. Lee, T., Tsai, I.C., Fu, Y.C., Wang, C.C., Chang, Y., Chen, M.C., 2006. Using multi detector CT in neonates with complex congenital heart disease to replace diagnostic cardiac catheterization for anatomical investigation: initial experiences in technical and clinical feasibility. Pediatr. Radiol. 36:1273-1282
• Referans18. Adaletli, İ., Barış, S., Kılıç, Özdil, M., Güzeltaş, A., Demir, T., Eroğlu, A. G., Kurugoğlu, S., 2011. Multislice computed tomography angiography is a sufficient method for detecting native aortic coarctation in children. Turk. J. Thorac. Cardiovasc. Surg.19, 361-365
• Referans19. Stone, W., Brewster, D., Moncure, A., Franklin, D., Cambria, R., Abbott W., 1990. Aberrant right subclavian artery: varied presentations and management options. J. Vasc. Surg. 11,812-7.
• Referans20. Kieffer, E., Bahnini, A., Koskas, F., 1994. Aberrant subclavian artery: Surgical treatment in thirty-three adult patients. J. Vasc. Surg. 19,100-1.
• Referans21. Huang, F., Chen, Q., Huang, W.H., Wu, H., Li, W.C., Lai, Q.Q., 2017. Diagnosis of Congenital Coarctation of the Aorta and Accompany Malformations in Infants by Multi-Detector Computed Tomography Angiography and Transthoracic Echocardiography: A Chinese Clinical Study. Med, Sci, Monit.23,2308-14
• Referans22. Karcaaltincaba, M., Haliloglu, M., Ekinci, S., 2004. Partial tracheal duplication: MDCT bronchoscopic diagnosis. A.J.R. Am. J. Roentgenol. 183,290-2