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Xiao HJ, Lin WH, Zheng SY, Cai YY. Application of Computed Tomography Angiography in Preoperative Diagnosis of Coarctation of Aorta and Evaluation of Aortic Dilatation in Infants. Braz J Cardiovasc Surg 2024; 39:e20230160. [PMID: 38629955 PMCID: PMC11021031 DOI: 10.21470/1678-9741-2023-0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/22/2023] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To evaluate the occurrence of aortic dilatation and its associated predictors with coarctation of the aorta (CoA) in infants using multi-slice computed tomography (MSCT). METHODS The clinical data of 47 infantile patients with CoA diagnosed by MSCT and 28 infantile patients with simple ventricular septal defect were analyzed retrospectively. Aortic diameters were measured at six different levels, and aortic sizes were compared by z score. The coarctation site-diaphragm ratio was used to describe the degree of narrowing. Relevant clinical data were collated and analyzed. RESULTS The dilation rate and z score of the ascending aorta in the severe CoA group were significantly higher than those in the mild CoA group (11 [52.38%] vs. 21 [80.77%], P=0.038 and 2.00 ± 0.48 vs. 2.36 ± 0.43, P=0.010). Pearson's correlation analysis found that the z score of the ascending aorta was negatively correlated with the coarctation site-diaphragm ratio value (r=-0.410, P=0.004). A logistic retrospective analysis found that an increased degree of coarctation was an independent predictor of aortic dilatation (adjusted odds ratio 0.002; 95% confidence interval 0.00-0.819; P=0.043). The z score of the ascending aorta in the severe CoA group was significantly higher than that in the ventricular septal defect group (P<0.05). CONCLUSION Most infants with CoA can also have significant dilatation of the ascending aorta, and the degree of this dilatation is related to the degree of coarctation. Assessment of aortic diameter and related malformations by MSCT can predict the risk of aortic dilatation in infants with CoA.
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Affiliation(s)
- Hui-Jun Xiao
- Department of Radiology, Zhangzhou Affiliated Hospital of Fujian
Medical University, Zhangzhou, People’s Republic of China
| | - Wei-Hua Lin
- Department of Radiology, Zhangzhou Affiliated Hospital of Fujian
Medical University, Zhangzhou, People’s Republic of China
| | - Shun-Yong Zheng
- Department of Radiology, Zhangzhou Affiliated Hospital of Fujian
Medical University, Zhangzhou, People’s Republic of China
| | - Yi-Yong Cai
- Department of Radiology, Zhangzhou Affiliated Hospital of Fujian
Medical University, Zhangzhou, People’s Republic of China
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Xiao HJ, Zhan AL, Huang QW, Huang RG, Lin WH. Evaluation of the aorta in infants with simple or complex coarctation of the aorta using CT angiography. Front Cardiovasc Med 2023; 9:1034334. [PMID: 36698954 PMCID: PMC9868234 DOI: 10.3389/fcvm.2022.1034334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To assess aortic dilatation and determine its related factors in infants with coarctation of the aorta (CoA) by using computed tomography angiography (CTA). Methods The clinical data of 55 infantile patients with CoA diagnosed by CTA were analyzed retrospectively. Aortic diameters were measured at six different levels and standardized as Z scores based on the square root of body surface area. The results of simple and complex CoA were compared. Univariate and multivariate logistic regression were used to analyze the effects of sex, age, hypertension, degree of coarctation, CoA type, bicuspid aortic valve (BAV), and other factors related to aortic dilatation. Results In total, 52 infant patients with CoA were analyzed, including 22 cases of simple CoA and 30 cases of complex CoA. The ascending aorta of the infants in the simple CoA group and the complex CoA group were dilated to different degrees, but the difference was not statistically significant (50.00% vs. 73.33%, P = 0.084, and 2.05 ± 0.40 vs. 2.22 ± 0.43 P = 0.143). The infants in the complex CoA group had more aortic arch hypoplasia than those in the simple CoA group (33.33% vs. 9.09%, P = 0.042). Compared to the ventricular septal defect (VSD) group, the Z score of the ascending aorta in the CoA group was significantly higher than that in the VSD group (P = 0.023 and P = 0.000). A logistic retrospective analysis found that an increased degree of coarctation (CDR value) was an independent predictor of ascending aortic dilatation (adjusted OR = 0.002; P = 0.034). Conclusion Infants with simple or complex CoA are at risk of ascending aortic dilatation, and the factors of ascending aortic dilatation depend on the degree of coarctation. The risk of aortic dilatation in infants with CoA can be identified by CTA.
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Wei L, Hu S, Gong X, Ahemaiti Y, Zhao T. Diagnosis of covert coarctation of the aorta in adolescents. Front Pediatr 2023; 11:1101607. [PMID: 37025297 PMCID: PMC10070858 DOI: 10.3389/fped.2023.1101607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Objectives By reviewing the diagnostic process for adolescents with coarctation of the aorta (CoA) in our institution, we analyzed the reasons for delayed diagnosis of CoA. We also proposed a diagnostic protocol to improve the detection rate of CoA. Methods In this retrospective study, we included 48 patients aged 12-18 years who were diagnosed with CoA in our hospital from January 2000 to November 2022. Clinical data from involved cases in local hospitals and our institution were collected. Results All patients had blood pressure (BP) measurements in upper and lower extremities in our institution. They all had hypertension, 29 (60.4%) of whom had known histories of the same. BP in the upper limbs of 47 (97.9%) patients was ≥20 mmHg higher than that in the lower limbs, and BP in the upper limb of 1 (2.1%) patient was greater than 0 and less than 20 mmHg than that in the lower limb. Echocardiography (ECHO) was performed in all patients, computed tomography (CT) or magnetic resonance imaging (MRI) was performed in 44 patients (91.7%). There were 38 (79.2%) patients who visited local hospitals. Among them, a total of 20 (52.6%) patients had their right upper extremity BP measured, 18 (47.4%) only had their left upper extremity BP measured, and 16 (42.1%) had their lower extremity BP measured. ECHO was performed in 27 (56.2%) patients and CT/MRI was performed in 18 (37.5%) patients. The detection rate for CT/MRI was 100%, and those of ECHO were 72.9% and 18.5% at our institution and a local hospital, respectively. Forty-eight (100%) and 23 (60.5%) patients were detected in our institution and local hospitals (P < 0.0001). Conclusion We recommend measuring BP in the bilateral upper extremities. Measurement of BP in the lower extremities is recommended if hypertension is diagnosed. MRI/CT is recommended when BP in the upper extremity is greater than that in the lower extremity.
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Xiao HJ, Zhan AL, Huang QW, Huang RG, Lin WH. Computed tomography angiography assessment of the degree of simple coarctation of the aorta and its relationship with surgical outcome: A retrospective analysis. Front Pediatr 2022; 10:1017455. [PMID: 36545667 PMCID: PMC9760797 DOI: 10.3389/fped.2022.1017455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/21/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To investigate the correlation between the degree of aortic coarctation and surgical prognosis in infants with simple coarctation of the aorta (CoA) using computed tomography angiography (CTA). METHODS This study was a retrospective study. Twenty-seven infants with simple CoA who underwent surgical correction from January 2020 to June 2022 were enrolled. Aortic diameters were measured at five different levels and normalized to Z scores based on the square root of body surface area. The relevant data were collected and analyzed, and the predictors associated with surgical outcome were determined. RESULTS Patients were divided into the mild CoA group and the severe CoA group according to the severity of coarctation. The mechanical ventilation duration and the length of ICU stay in the mild CoA group were significantly lower than those in the severe CoA group. Multiple linear regression analyses revealed that the degree of aortic coarctation was a significant risk factor for a prolonged postoperative ICU stay. In addition, gestational age and age at operation were risk factors for a prolonged postoperative ICU stay. Correlation analysis showed that the degree of aortic coarctation correlated with the Z scores of the ascending aorta and postcoarctation aorta. CONCLUSION The degree of the CoA is an important predictor of surgical outcomes in infants with simple CoA and was significantly correlated with the ascending aorta and postcoarctation aorta Z scores. Therefore, preoperative CTA should be routinely performed to assess the degree of aortic coarctation and better identify risk factors.
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Affiliation(s)
- Hui-Jun Xiao
- Department of Radiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - A-Lai Zhan
- Department of Radiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Qing-Wen Huang
- Department of Radiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Rui-Gang Huang
- Department of Radiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Wei-Hua Lin
- Department of Radiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
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Zhao Q, Shi K, Yang ZG, Diao KY, Xu HY, Liu X, Guo YK. Predictors of aortic dilation in patients with coarctation of the aorta: evaluation with dual-source computed tomography. BMC Cardiovasc Disord 2018; 18:124. [PMID: 29929466 PMCID: PMC6013956 DOI: 10.1186/s12872-018-0863-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/12/2018] [Indexed: 02/05/2023] Open
Abstract
Background Coarctation of aorta (CoA) may progressively develop aortic dilation at other site of the aorta and can lead to fatal aortic diseases. We aimed to evaluate the occurrence of aortic dilation and related predictors in patients with CoA using dual-source computed tomography (DSCT). Methods Fifty-three patients with CoA identified by DSCT were retrospectively reviewed. Aortic diameters were measured at six different levels and standardized as z-scores based on the square root of body surface area. Coarctation site–diaphragm ratio (CDR) was used to describe the degree of narrowing. A total of 26 patients were included in mild group (CDR > 50%) and 27 in severe group (CDR < 50%) according to the severity of coarctation. Student’s t-test and Spearman correlation coefficients, univariate and multivariable logistic regression analyses were used to assess the risk factors including age, degree of narrowing and other malformations for aortic dilation. Results Severe group had significantly larger z-scores of ascending aorta (2.41 ± 0.39 vs. 2.10 ± 0.57, p < 0.05) and post-coarctation aorta (2.17 ± 0.48 vs. 1.68 ± 0.43, p < 0.001) compared with mild group. Degree of coarctation was associated with the z-scores of the ascending aorta (r = − 0.356, p < 0.05) and post-coarctation aorta (r = − 0.414, p < 0.05). Collateral circulation was related to the z-scores of ascending aorta (r = 0.375, p < 0.05). Increased severity of coarctation was independent predictor of ascending (odds ratio 7.46; 95% CI 1.19–46.76; p < 0.05) and post-coarctation aortic dilation(odds ratio 8.42; 95% CI 1.84–38.56; p < 0.05). Conclusions Ascending and post-coarctation aortic diameters or dilations were both associated with the degree of coarctation. By comprehensively evaluating the aortic diameters and associated malformations including collateral circulation, DSCT can aid in stratification of risk for aortic dilation in patients with CoA. Electronic supplementary material The online version of this article (10.1186/s12872-018-0863-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qin Zhao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Kai-Yue Diao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Hua-Yan Xu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xi Liu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, Sichuan, China.
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Huang F, Chen Q, Huang WH, Wu H, Li WC, Lai QQ. 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 2017; 23:2308-2314. [PMID: 28510540 PMCID: PMC5441492 DOI: 10.12659/msm.901928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study was to evaluate the utility of multi-detector computed tomography (MDCT) angiography and transthoracic echocardiography (TTE) in the diagnosis of congenital coarctation of the aorta (CoA) and accompanying malformations in infants. Material/Methods From January 2012 and December 2015, we enrolled 68 infants with clinically suspected CoA who underwent MDCT angiography and TTE in our hospital. Surgical correction was conducted to confirm the diagnostic accuracy of both examinations in all patients. Results In this study, the diagnosis of CoA was confirmed infants by surgical results in 55 of 68 infants. The diagnostic accuracy, sensitivity, and specificity of MDCT angiography were 95.6%, 96.4%, and 92.3%, respectively. The diagnostic accuracy, sensitivity, and specificity of TTE were 88.2%, 90.9%, and 76.9%, respectively. There was no significant difference in diagnostic accuracy, sensitivity, and specificity between MDCT angiography and TTE (χ2=2.473, p>0.05, χ2=1.373, p>0.05 and χ2=1.182, p>0.05, respectively). In the diagnosis of concomitant cardiac abnormalities with CoA, the 2 methods also play different roles. Conclusions MDCT angiography and TTE play different roles in the diagnosis of CoA and accompany malformations. MDCT angiography in the diagnosis of the extra-cardiac vascular malformations is better than TTE, and TTE is superior to MDCT angiography in diagnosing intracardiac malformation. Combined MDCT angiography and TTE is a relatively valuable, reliable, and noninvasive method in the diagnosis of CoA and accompany malformations in infants.
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Affiliation(s)
- Fang Huang
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China (mainland)
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Wen-Han Huang
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China (mainland)
| | - Hong Wu
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China (mainland)
| | - Wei-Cheng Li
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China (mainland)
| | - Qing-Quan Lai
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China (mainland)
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