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.

Adolescences Hypertension: A Late Case of Coarctation of Aorta: A Case Report and Short Review of Literature

“…This finding with additional diminished or delayed femoral arterial pulses has been thought in the past to be the gold standard findings that points directly to CoA [5]. Newly studies show that these clinical findings are only present in near 60% of patients suffering from CoA [10]. Additional evidence can be added by a Chest X-Ray, showing a "figure of three" sign formed by the aortic nob, the stenotic segment, and the dilated post-stenotic segment of the aorta, suggesting CoA ( Figure 1).…”

“…Page 3 of 7 [10] (Figure 4). Color mapping and Doppler examination improves the diagnostic accuracy [5,10].…”

“…Page 3 of 7 [10] (Figure 4). Color mapping and Doppler examination improves the diagnostic accuracy [5,10]. Meanwhile Echo-2D will detect any additional anatomic lesions as discussed above as well as the function of the CVS [5,8,10].…”

“…A variety of diagnostic methods can be added to prove the existence of CoA and quantify its severity. Less invasive, cheap and easy to provide in all levels of care, today is Echocardiography (Echo-2D) [10]. As CoA is "classically" divided to pre-and -post DA, we will follow this classification when describing Echo-2D and Computer Tomography (CT) angiography findings.…”

“…In the pre-ductal type of CoA, the inner diameters of distal aortic arch and aortic isthmus narrow significantly, and the aortic arch and/ or DAo reveal an irregular stricture. In the post ductal CoA type, the DAo constriction is located distal to the left subclavian artery presenting a gourd-shaped appearance [10] (Figure 3). In postductal type, the distal DAo presents a dilatation after the CoA area…”