The role of CT angiography in preoperative evaluation of aortic coarctation

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

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