Evaluation of Aortic Arch Anomalies by Echocardiography and CT Angiography, Could CT be the Primary Method of Diagnosis?

Abstract

Aims: In our study we highlight the importance of noninvasive imaging, stressing the role of CTA over echocardiography in the diagnosis of congenital aortic arch anomalies. Study Design: Prospective design. Place and Duration of Study: Radiology and pediatric department, in Cairo University children’s hospital, over the period of 15 months from February 2011 to April 2012. Methodology: Forty five patients (23 males and 22 females) were examined in this study; they were referred to the pediatric cardiology outpatient clinic in Cairo university children’s hospital, by history or clinical examination suspicious of aortic arch anomalies. For each patient full history and clinical examination were obtained including: age, sex, residence, consanguinity, cardiac manifestations weak or absent femoral pulsations, abnormal gradient in blood pressure between upper and lower limbs (>20 mmhg). Echocardiography was done and if aortic arch anomalies were diagnosed; the patient referred to do CT angiography of the heart after taking clear consent from the patient’s parents. Results: Our study included 45 patients, their age range (5 days -11 years), they were 23 males and 22 females, with the following diagnosis: 15 had hypoplastic aortic arch by echocardiography, 6 of them proved to have multiple levels of narrowing by CT angiography, 11patients had aortic coarctation by echocardiography, 3 of them were proved to have more than one segmental narrowing by CT angiography and one patient had hypoplasia of the whole aorta. Six patients had tetralogy of Fallot with right sided aortic arch, mirror imaging branches or aberrant left subclavian artery and hypoplastic pulmonary trunk. Four patients had interrupted aortic arch. One patient had aneurysmal dilatation of ascending aorta and aortic arch. One patient had aortopulmonary window. Six patients had persistent truncus arteriosus.