Noninvasive assessment of coarctation of the aorta: Comparative measurements by two-dimensional echocardiography, magnetic resonance, and angiography

Abstract

Fifteen patients, aged between 9 and 21 years (mean, 15.1), with native coarctation of the aorta (CoA) or suspected recoarctation after surgical repair, underwent three different diagnostic procedures. Two-dimensional echocardiography (2D echo) and magnetic resonance imaging (MRI) of the thoracic aorta were performed in all patients; 14 patients underwent aortography, and digital subtraction angiography of the aorta was performed in one (after injection via a central venous catheter). Conventional electrocardiographic (ECG) gated MRI was performed, using the sagittal plane, a 256 x 256 acquisition matrix, multi-slice technique and a slice thickness of 10 mm. Diameters at the coarctation site were determined by all methods. Additional diameters of the descending aorta and the aortic arch were measured by MRI and echocardiography, respectively. All noninvasively obtained diameters were compared with angiographic data. Ultrasound imaging of the aortic isthmus was achieved in seven of 15 patients and of the aortic arch in nine of 15. The mean difference compared with angiographically determined diameters was 1.7 (0-7) mm, being greater for the coarctation site [mean, 2.2 (0-4)]. MRI images of the aortic isthmus were obtained in all patients, but the difference to angiographically determined diameters was slightly higher [mean, 3.2 mm (0-8)] than the ultrasound results. This deviation was presumably due to technical conditions, such as slice thickness and orthogonal imaging planes. Including all diameters, the correlation to invasive measurements was r = 0.82 (SEM = 3.1) for MRI and r = 0.89 (SEM = 2.3) for echo recordings.(ABSTRACT TRUNCATED AT 250 WORDS)

Magnetic resonance imaging demonstration of “Remodeling” of the aorta following balloon angioplasty of discrete native coarctation

“…Although MRI has been utilized for the pre-and postoperative assessment of coarctation of the aorta [1,2,9,10], the anatomic changes that occur proximally, distally, and at the coarctation site after balloon angioplasty using this modality are largely unrecognized.…”

“…The definition of an aneurysm is somewhat subjective, and documentation via angiography and echocardiography is limited by the inability to evaluate the aortic lumen and vessel wall in multiple planes. Previous reports have demonstrated the efficacy of magnetic resonance imaging (MRI) versus angiography and echocardiography for assessing coarctation of the aorta pre-and postoperatively [1,2,9,10]. Successful balloon angioplasty results in normalization of flow across the previously dilated aortic segment, which leads to ''remodeling'' and growth of the arch [4,8].…”

Comparison of arterial waves derived by classical wave separation and wave intensity analysis in a model of aortic coarctation

“…In addition, we increased the wall stiffness by doubling Young's modulus from 2 to 4 9 10 5 Pa. Both the maximal severity of the luminal narrowing and the increase in aorta stiffness were within recorded limits of aortic coarctation in humans [15,19]. Heart rate was modeled as constant, at 73 beats per minute, and cardiac output was kept unchanged.…”

Morphometric Analysis of Aortic Coarctation Determination of the Target Vessel Diameter Required to Relieve the Pressure Gradient

“…A number of methods and indices have been used to assess the severity of CoA. [1][2][3][4] Angiographic measurement of the diameter of the narrowest aortic segment indexed to that of the DAo at the diaphragm is still widely used for evaluation of the severity of CoA. 1 Table 1.…”