Diagnosis and surgical outcomes of coarctation of the aorta in pediatric patients: a retrospective study

Ting Gong; Feiyan Zhang; Lingxin Feng; Xu Zhu; Dan Deng; Tingting Ran; Liling Li; Li Kong; Liqun Sun; Xiaojuan Ji

doi:10.3389/fcvm.2023.1078038

Diagnosis and surgical outcomes of coarctation of the aorta in pediatric patients: a retrospective study

Front Cardiovasc Med. 2023 Jul 24:10:1078038. doi: 10.3389/fcvm.2023.1078038. eCollection 2023.

Authors

Ting Gong^#^{1

2}, Feiyan Zhang^#^{2

3}, Lingxin Feng², Xu Zhu², Dan Deng⁴, Tingting Ran², Liling Li², Li Kong², Liqun Sun⁵, Xiaojuan Ji^{2

6}

Affiliations

¹ Department of Ultrasound, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
² Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.
³ Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing, China.
⁴ School of Medical Imaging, Changsha Medical University, Changsha, China.
⁵ Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
⁶ Department of Ultrasound, Chongqing General Hospital, Chongqing, China.

^# Contributed equally.

Abstract

Background: Coarctation of the aorta (CoA) is a common congenital cardiovascular malformation, and improvements in the diagnostic process for surgical decision-making are important. We sought to compare the diagnostic accuracy of transthoracic echocardiography (TTE) with computed tomographic angiography (CTA) to diagnose CoA.

Methods: We retrospectively reviewed 197 cases of CoA diagnosed by TTE and CTA and confirmed at surgery from July 2009 to August 2019.

Results: The surgical findings confirmed that 19 patients (9.6%) had isolated CoA and 178 (90.4%) had CoA combined with other congenital cardiovascular malformations. The diagnostic accuracy of CoA by CTA was significantly higher than that of TTE (χ² = 6.52, p = 0.01). In contrast, the diagnostic accuracy of TTE for associated cardiovascular malformations of CoA was significantly higher than that of CTA (χ² = 15.36, p < 0.0001). Infants and young children had more preductal type of CoA, and PDA was the most frequent cardiovascular lesion associated with CoA. The pressure gradient was significantly decreased after the first operation, similar at 6 months, 1 year, and 3 years follow-ups by TTE.

Conclusions: CTA is more accurate as a clinical tool for diagnosing CoA; however, TTE with color Doppler can better identify associated congenital cardiovascular malformations. Therefore, combining TTE and CTA would benefit clinical evaluation and management in patients suspected of CoA. TTE was valuable for post-operation follow-up and clinical management.

Keywords: coarctation of the aorta; computed tomographic angiography; congenital heart disease; surgical outcome; transthoracic echocardiography.

Grants and funding

This work was funded by the National Natural Science Foundation of China (Grant No. 81301300), Project of Chongqing Municipal Human Resources and Social Security Bureau (cx2019065), and Chongqing Health Commission Appropriate Technology Extension Project (2021jstg007).