Cardiology Letters 2013, 22(6):445-448

Echocardiography and MR evaluation of aortic coarctation and recoarctation-influence of aortic arch deformity and isthmic tortuosity

Berecova Z¹, Neuschl V¹, Boruta P¹, Masura J², Kaldararova M², Simkova I³

¹ Department of Radiology, Slovak Health Care University, Bratislava

² Clinic of Cardiology, Slovak Health Care University, Bratislava, The National Institute of Cardiovascular Disease in Bratislava

³ The National Institute of Cardiovascular Disease in Bratislava - Children´s Cardiocentrum, Bratislava, Slovak Republic

Objective: Peak systolic velocity measured by echocardiography (ECHO) and velocity-encoded magnetic resonance (venc MR) and consequently converted gradients are influenced by several conditions. One of these is the tortuosity of the vessel. The purpose of this study was to determine the feasibility and accuracy of echocardiography and venc MR in gradient measurement over the aortic isthmus in the case of aortic arch deformity and aortic isthmus tortuosity.

Background: Aortic coarctation is a narrowing in the descending aorta at the insertion site of the ductus arteriosus Botalli (DAB). Pseudocoarctation as well as kinking at the site of aortic isthmus or postoperative aortic arch deformity influences the hemodynamic in the descending aorta.

Patients and methods: 16 patients were included in the study (6 females, 10 males; mean age 18 years; range 8-37 years). 14 patients came in with diagnosis of simple aortic coactation, 1 had aortic coarctation in association with double outlet right ventricle and one with Taussig-Bing anomaly. 14 patients had aortic coarctation surgically repaired in the past. Peak systolic velocities over the aortic isthmus were measured and converted to gradients using ECHO and venc MR and consequently were compared with MR angiography (MRAG) as a standard method. Stenosis measurement and tortuosity of each vessel were analyzed on MRAG.

Results: Gradient estimation by ECHO correlated well with gradient measurement on venc MR (r=0.73, P=0.01). Specificity of venc MR was 0.75. All included ECHO measurements were false positive. The limits of agreement between measurements by venc MR and ECHO were from 1.23 to 33.39, which confirm the lack of agreement between-above-mentioned methods.

Conclusion: In the case of aortic arch deformity or isthmic tortuosity MR evaluation of aortic isthmus, including venc MR and MR angiography is more feasible for determination of the aortic coarctation or recoarctation compare to gradient measurement using echocardiography. Fig. 4, Tab. 1, Online full text (Free, PDF) www. cardiology.sk

Keywords: aortic coarctation; pseudocoarctation; aortic arch deformity; gradient measurement

Published: June 1, 2013  Show citation