Diagnostic Value of Transthoracic Echocardiography in Patients with Coarctation of Aorta: The Chinese Experience in 53 Patients Studied between 2008 and 2012 in One Major Medical Center

Abstract

Although aortography is well known as the "gold standard" for the diagnosis of coarctation of aorta (CoA), the method is invasive, expensive and not readily accepted by some patients. Ultrasound diagnosis for CoA is non-invasive, inexpensive, readily accepted by every patient, and can be repeated as frequently as necessary. The purpose of this presentation is to evaluate the applicability of transthoracic echocardiography for the diagnosis of CoA. The echocardiographic appearances of 53 patients with CoA who had undergone surgery during a 5-year period from January 2008 to October 2012 were analyzed retrospectively, and the results were compared with findings at surgery. Fifty-three patients with CoA include six with isolated CoA and 47 of CoA associated with other cardiac anomalies. Of the 53 operated patients, 48 were correctly diagnosed preoperatively by echocardiography, while two were misdiagnosed as interrupted aortic arch and the diagnosis were missed in three other patients. Thus the diagnostic accuracy rate was 90.6%, and the misdiagnosis rate was 9.4%. Preoperative echocardiographic evaluation offers very satisfactory anatomic assessment in most patients with CoA. It makes preoperative angiography unnecessary. Thus transthoracic echocardiography should be the first-line method for the diagnosis of coarctation of the aorta.

Fig 1. The age distribution of 53 patients with CoA.

Fig 2. Transthoracic echocardiograms in suprasternal view of a 2-month-old boy showing[A] the location of the coarctation of aorta (CoA) between the ascending aorta (AAO) and descending aorta (DAO), [B] dilatation of the aorta after the CoA, and [C] high speed flow in the CoA.

Computed tomographic angiography [D] obtained at 5 months of age confirmed the location of the CoA.

Fig 3. Transthoracic echocardiograms in suprasternal view of a 3-month-old girl showing [A] the location of the CoA, [B] the high flow signal in the CoA, and [C] characteristics of the CoA by continuous wave Doppler, including high speed jet spectrum during systole and extended speed reduction during diastole.

Computed tomographic angiography [D,E] showed the location of the CoA. At surgery [F], the location of the CoA was confirmed. Abbreviations as in Fig 2.

Fig 4. Transthoracic echocardiograms in suprasternal view of a 4-month-old boy showing [A] the location of the CoA between AAO and DAO and [B] the high speed flow signal in the CoA.

Computed tomographic angiography [C] showed the location of the CoA. Abbreviations as in Fig 2.

Fig 5. Transthoracic echocardiograms in suprasternal view of a19-year-old boy showing [A] the location of the CoA and [B]characteristics of the CoA by continuous wave Doppler, including high speed jet spectrum during systole and extended speed reduction during diastole.

[C] Aortic angiography showed the location of the CoA. Abbreviations as in Fig 2.