Regional Arch Measurements Differ Between Imaging Modalities in Infants With Aortic Coarctation

John Iguidbashian; LaDonna J Malone; Lorna P Browne; Michael Nguyen; Benjamin Frank; Michal Schafer; David N Campbell; Max B Mitchell; James Jaggers; Matthew L Stone

doi:10.1016/j.athoracsur.2023.11.027

Regional Arch Measurements Differ Between Imaging Modalities in Infants With Aortic Coarctation

Ann Thorac Surg. 2023 Dec 10:S0003-4975(23)01243-2. doi: 10.1016/j.athoracsur.2023.11.027. Online ahead of print.

Authors

Affiliations

¹ Division of General Surgery, Department of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado. Electronic address: john.iguidbashian@cuanschutz.edu.
² Department of Radiology, Children's Hospital of Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
³ Division of Cardiology, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
⁴ Division of General Surgery, Department of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
⁵ Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.

PMID: 38072352
DOI: 10.1016/j.athoracsur.2023.11.027

Abstract

Background: Aortic arch measurements provide a framework for surgical decision-making in neonatal aortic coarctation, specifically in the determination of approach for arch repair by lateral thoracotomy vs median sternotomy. The purpose of this study was to evaluate our experience with transthoracic echocardiography (TTE) and computed tomography angiography (CTA) in the preoperative evaluation of infants with aortic coarctation, specifically comparing arch dimensions as a function of imaging modality.

Methods: Imaging data were reviewed for all infants undergoing surgical repair of aortic coarctation at our institution from 2012 to 2022. Infants with both TTE and CTA evaluations were included. Aortic measurements were compared at predefined anatomic regions including ascending aorta, proximal arch, distal arch, and isthmus.

Results: During the study period, 372 infants underwent surgical coarctation repair; 72 (19.4%) infants had TTE and CTA arch evaluations preoperatively. Significant discrepancies between imaging modalities were defined by poor correlation coefficients and absolute measurement differences and were most prominent in the proximal aortic arch (R² = 0.23 [-4.4 to 3.2 mm]) and isthmus regions (R² = 0.11 [-4.2 to 1.7 mm]). Improved correlation was demonstrated in the ascending aorta (R² = 0.63) and distal aortic arch (R² = 0.54).

Conclusions: Significant variability exists between TTE- and CTA-derived aortic measurements in infants with coarctation, with proximal arch measurements demonstrating the poorest correlation. This anatomic location represents a commonly used arch region for the determination of approach for repair of neonatal aortic coarctation. Thus, these findings have important implications for current preoperative surgical decision-making paradigms and future prospective study to minimize the risk of residual or recurrent arch obstruction.