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Ezzahi M, Bijbij A, Akammar A, El Bouardi N, Haloua M, Lamrani MYA, Boubbou M, Maaroufi M, Alami B. Incidental finding of undiagnosed aortic coarctation in an elderly patient with a rare association with thymic carcinoma: a case report with review of the literature. Radiol Case Rep 2023; 18:3317-3322. [PMID: 37483377 PMCID: PMC10362250 DOI: 10.1016/j.radcr.2023.07.003] [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: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023] Open
Abstract
Aortic coarctation is a congenital malformation that is relatively prevalent, occurring in approximately 5 out of every 1000 births. The narrowing typically happens at the aortic isthmus between the left subclavian artery and the arterial ligament. It is frequently associated with a bicuspid aortic valve. Generally, coarctation of the aorta is identified and treated during childhood or early adulthood. If left untreated, this condition can lead to a reduced life expectancy in individuals who have not received treatment. We present a case of a 52-year-old man who complained of chest pain, sputum, and hemoptysis persisting for approximately 2 years. Contrast-enhanced computed tomography (CT) scans revealed the presence of an anterior mediastinal mass, which was later confirmed to be a thymic carcinoma (on histological study). Additionally, an incidental finding of a thoracic aortic coarctation with a well-developed collateral circulation was observed. The discovery of aortic coarctation in adult patients as an incidental finding is rare and particularly uncommon in association with mediastinal or thoracic tumor pathology. Adult and elderly patients with uncorrected coarctation generally have a low survival rate, and the management strategies for such cases are controversial, especially when it is associated to other pathologies. Due to the complexity of therapeutic management and the limited literature available on postsurgical outcomes in these cases, making therapeutic decisions requires a multidisciplinary approach and personalized consideration for each individual case. This approach is necessary to evaluate the risk-benefit ratio and determine the most suitable therapeutic solution.
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Asad I, Lee MS, Banihani R, Wong PD, Etoom Y. Coarctation of the Aorta in Adolescence: Significance of Detailed Cardiac Examination in Pediatric Hypertension. Pediatr Emerg Care 2021; 37:e1724-e1725. [PMID: 30973498 DOI: 10.1097/pec.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Although coarctation of the aorta (CoAo) is a congenital anomaly, it can pose a diagnostic challenge in those presenting beyond neonatal period, as some patients can remain asymptomatic until complications of hypertension develop later in life. Careful physical examination can play an important role in timely diagnosis and prevention of complications.We present 2 cases of adolescents with undiagnosed CoAo who both presented with nonspecific headaches and hypertension. Both were initially misdiagnosed as essential hypertension until careful detailed physical examination later detected weak/absent femoral pulses and discrepancy in upper and lower limb blood pressures. These findings raised the clinical suspicion of CoAo, which was confirmed on further investigations.Our cases highlight the importance of considering CoAo in the differential diagnosis of hypertension in adolescents. These cases also stress the significance of detailed cardiac examination including 4-limb blood pressure and femoral pulses in a patient presenting to the emergency department with high blood pressure irrespective of the primary complaint.
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Gunn AJ, Kalva SP, Majdalany BS, Craft J, Eldrup-Jorgensen J, Ferencik M, Ganguli S, Kendi AT, Khaja MS, Obara P, Russell RR, Sutphin PD, Vijay K, Wang DS, Dill KE. ACR Appropriateness Criteria® Nontraumatic Aortic Disease. J Am Coll Radiol 2021; 18:S106-S118. [PMID: 33958105 DOI: 10.1016/j.jacr.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 01/16/2023]
Abstract
Nontraumatic aortic disease can be caused by a wide variety of disorders including congenital, inflammatory, infectious, metabolic, neoplastic, and degenerative processes. Imaging examinations such as radiography, ultrasound, echocardiography, catheter-based angiography, CT, MRI, and nuclear medicine examinations are essential for diagnosis, treatment planning, and assessment of therapeutic response. Depending upon the clinical scenario, each of these modalities has strengths and weaknesses. Whenever possible, the selection of a diagnostic imaging examination should be based upon the best available evidence. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. The purpose of this document is to assist physicians select the most appropriate diagnostic imaging examination for nontraumatic aortic diseases.
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Affiliation(s)
- Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama, Director, Interventional Oncology, Director, Ambulatory Clinic, Assistant Program Director, Diagnostic Radiology Residency, Assistant Program Director, Interventional Radiology Residency, University of Alabama at Birmingham, Member, American College of Radiology-Radiologic Society of North America Patient Information Committee.
| | - Sanjeeva P Kalva
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts, Chief, Division of Interventional Radiology, Massachusetts General Hospital
| | | | - Jason Craft
- St. Francis Hospital, Catholic Health Services of Long Island, Roslyn, New York, Society for Cardiovascular Magnetic Resonance
| | - Jens Eldrup-Jorgensen
- Tufts University School of Medicine, Boston, Massachusetts, Society for Vascular Surgery
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, Society of Cardiovascular Computed Tomography
| | | | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota, Director of Nuclear Medicine Therapies at Mayo Clinic Rochester
| | - Minhajuddin S Khaja
- University of Virginia, Charlottesville, Virginia, Vice-Chair ACR Vascular Imaging Panel 2, Program Director, Independent IR Residency, UVA Health
| | - Piotr Obara
- Loyola University Medical Center, Maywood, Illinois
| | - Raymond R Russell
- The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, Nuclear cardiology expert, Program Director, Cardiology Fellowship, Director, Nuclear Cardiology, Director, Cardio-Oncology Program, Rhode Island Hospital
| | | | | | - David S Wang
- Stanford University Medical Center, Stanford, California
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
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Windsor J, Mukundan C, Stopak J, Ramakrishna H. Analysis of the 2020 European Society of Cardiology (ESC) Guidelines for the Management of Adults With Congenital Heart Disease (ACHD). J Cardiothorac Vasc Anesth 2021; 36:2738-2757. [PMID: 33985885 DOI: 10.1053/j.jvca.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 01/02/2023]
Abstract
Adult congenital heart disease (ACHD) continues to rapidly increase worldwide. With an estimated 1.5 million adults with ACHD in the USA alone, there is a growing need for better education in the management of these complex patients and multiple knowledge gaps exist. This manuscript comprehensively reviewed the recent (2020) updated European Society of Cardiology Guidelines for the management of ACHD created by the Task Force for the management of adult congenital heart disease of the European Society of Cardiology, with perioperative implications for the adult cardiac anesthesiologist and intensivist who may be called upon to manage these complex patients.
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Affiliation(s)
- Jimmy Windsor
- Clinical Associate Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Chaitra Mukundan
- Clinical Assistant Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Joshua Stopak
- Clinical Assistant Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Harish Ramakrishna
- Professor of Anesthesiology, Mayo Clinic School of Medicine, Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular and Thoracic Anesthesiology, 200 First Street SW, Rochester, MN 55905.
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Evaluating the severity of aortic coarctation in infants using anatomic features measured on CTA. Eur Radiol 2020; 31:1216-1226. [PMID: 32885294 DOI: 10.1007/s00330-020-07238-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/26/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES A machine learning model was developed to evaluate the severity of aortic coarctation (CoA) in infants based on anatomical features measured on CTA. METHODS In total, 239 infant patients undergoing both thorax CTA and echocardiography were retrospectively reviewed. The patients were assigned to either mild or severe CoA group based on their pressure gradient on echocardiography. They were further divided into patent ductus arteriosus (PDA) and non-PDA groups. The anatomical features were measured on double-oblique multiplanar reconstructed CTA images. Then, the optimal features were identified by using the Boruta algorithm. Subsequently, the coarctation severity was classified using linear discriminant analysis (LDA). We further investigated the relationship between the anatomical features and re-coarctation using Cox regression. RESULTS Four anatomical features showed significant differences between the mild and severe CoA groups, including the smallest aortic cross-sectional area indexed to body surface area (p < 0.001), the narrowest aortic diameter (CoA diameter) indexed to height (p < 0.001), the diameter of the descending aorta at the diaphragmatic level (p < 0.001) and weight (p = 0.005). With these features, accuracy of 88.6% and 90.2%, sensitivity of 65.0% and 72.1%, and specificity of 92.9% and 100% were obtained for classifying the CoA severity in the non-PDA and PDA groups, respectively. Moreover, CoA diameter indexed to weight was associated with the risk of re-coarctation. CONCLUSIONS CoA severity can be evaluated by using LDA with anatomical features. When quantifying the severity of CoA and risk of re-coarctation, both anatomical alternations at the CoA site and the growth of the patients need to be considered. KEY POINTS • CTA is routinely ordered for infants with coarctation of the aorta; however, whether anatomical variations observed with CTA could be used to assess the severity of CoA remains unknown. • Using the diameter and area of the coarctation site adjusted to body growth as features, the LDA model achieved an accuracy of 88.6% and 90.2% in differentiating between the mild and severe CoA patients in the non-PDA group and PDA group, respectively. • The narrowest aortic diameter (CoA diameter) indexed to weight has a hazard ratio of 10.29 for re-coarctation.
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Sadeghi R, Khodaei S, Ganame J, Keshavarz-Motamed Z. Towards non-invasive computational-mechanics and imaging-based diagnostic framework for personalized cardiology for coarctation. Sci Rep 2020; 10:9048. [PMID: 32493936 PMCID: PMC7271217 DOI: 10.1038/s41598-020-65576-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/01/2020] [Indexed: 12/24/2022] Open
Abstract
Coarctation of the aorta (COA) is a congenital narrowing of the proximal descending aorta. Although accurate and early diagnosis of COA hinges on blood flow quantification, proper diagnostic methods for COA are still lacking because fluid-dynamics methods that can be used for accurate flow quantification are not well developed yet. Most importantly, COA and the heart interact with each other and because the heart resides in a complex vascular network that imposes boundary conditions on its function, accurate diagnosis relies on quantifications of the global hemodynamics (heart-function metrics) as well as the local hemodynamics (detailed information of the blood flow dynamics in COA). In this study, to enable the development of new non-invasive methods that can quantify local and global hemodynamics for COA diagnosis, we developed an innovative fast computational-mechanics and imaging-based framework that uses Lattice Boltzmann method and lumped-parameter modeling that only need routine non-invasive clinical patient data. We used clinical data of patients with COA to validate the proposed framework and to demonstrate its abilities to provide new diagnostic analyses not possible with conventional diagnostic methods. We validated this framework against clinical cardiac catheterization data, calculations using the conventional finite-volume method and clinical Doppler echocardiographic measurements. The diagnostic information, that the framework can provide, is vitally needed to improve clinical outcomes, to assess patient risk and to plan treatment.
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Affiliation(s)
- Reza Sadeghi
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Javier Ganame
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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Abstract
Coarctation of aorta (CoA) is a discrete narrowing in aorta causing obstruction to the flow of blood. It accounts for 6–8% of all congenital heart diseases. With advances in fetal echocardiography rate of prenatal diagnosis of coarctation of aorta has improved but it still remains a challenging diagnosis to make prenatally. Transthoracic echocardiography is mainstay of making initial diagnosis and routine follow-up. Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) are great advanced imaging tools for two-dimensional and three-dimensional imaging of aortic arch in complex cases. Based on type of coarctation, size of patient, severity of lesion, and associated abnormalities various management options like surgical treatment, transcatheter balloon angioplasty and transcatheter stent implantation are available. There is significant improvement in long-term survival from pre-surgical era to post-surgical era. But, among the postsurgical era patients, the long-term survival has not significantly changed between older and contemporary cohort. Patients with coarctation of aorta need lifelong follow-up event after successful initial intervention.
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Affiliation(s)
- Arpan R Doshi
- Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Wichita, USA
| | - Sathish Chikkabyrappa
- Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, USA
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Namazi MH, Safi M, Momenizadeh A, Khaheshi I, Memaryan M, Movahed MR. Mahaim fibers coexisting with coarctation of aorta and bicuspid aortic valve. Future Cardiol 2018; 14:483-489. [PMID: 30421621 DOI: 10.2217/fca-2017-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We found a coexistence of Mahaim fibers, coarctation of aorta and bicuspid valve in a young patient presenting with palpitations and subraventricular tachycardia. This rare combination of these three congenital cardiac abnormalities occurring in the same patient has not been reported previously. Detailed cardiac studies unmasked the patient's cardiac abnormalities. Furthermore, successful percutaneous intervention in treating coarctation and catheter-based ablation of Mahaim fibers were performed with resolution of symptoms. This case is discussed here in detail, alongside a review of the literature.
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Affiliation(s)
- Mohammad H Namazi
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Safi
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Momenizadeh
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isa Khaheshi
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Memaryan
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad R Movahed
- Department of Medicine, University of Arizona, School of Medicine, Tucson, Arizona, USA.,Care More Health, 7901 E Speedway, Tucson, Arizona, AZ 85710, USA
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Hui PKT, Goo HW, Du J, Ip JJK, Kanzaki S, Kim YJ, Kritsaneepaiboon S, Lilyasari O, Siripornpitak S. Asian consortium on radiation dose of pediatric cardiac CT (ASCI-REDCARD). Pediatr Radiol 2017; 47:899-910. [PMID: 28435986 DOI: 10.1007/s00247-017-3847-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/17/2017] [Accepted: 03/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND With incremental utilization of pediatric cardiac CT in congenital heart disease, it is imperative to define its current radiation dose levels in clinical practice in order to help imagers optimize CT protocols, particularly in Asia and other developing countries where CT physicists are not readily available. OBJECTIVE To evaluate current radiation dose levels and influencing factors in cardiac CT in children with congenital heart disease in Asia by conducting a retrospective multi-center, multi-vendor study. MATERIALS AND METHODS We included 1,043 pediatric cardiac CT examinations performed in 8 centers between January 2014 and December 2014 to evaluate congenital heart disease. In five weight groups, we calculated radiation dose metrics including volume CT dose index, size-specific dose estimate, dose-length product and effective dose. Age at CT exam, gender, tube voltage, scan mode, CT indication and image reconstruction algorithm were analyzed to learn whether they influenced CT radiation dose. RESULTS Volume CT dose index, size-specific dose estimate, dose-length product and effective dose of pediatric cardiac CT showed variations in the range of 4.3-23.8 mGy, 4.9-17.6 mGy, 55.8-501.3 mGy∙cm and 1.5-3.2 mSv, respectively, within five weight groups. Gender, tube voltage, scan mode and cardiac function assessment significantly influenced CT radiation dose. CONCLUSION This multi-center, multi-vendor study demonstrated variations in radiation dose metrics of pediatric cardiac CT reflecting current practice in Asia. Gender, tube voltage, scan mode and cardiac function assessment should be considered as essential radiation dose-influencing factors in developing optimal pediatric cardiac CT protocols.
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Affiliation(s)
- Peter K T Hui
- Department of Radiology, Hong Kong Baptist Hospital, Hong Kong, SAR, China
| | - Hyun Woo Goo
- Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
| | - Jing Du
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Janice J K Ip
- Department of Radiology, Queen Mary Hospital, Hong Kong, SAR, China
| | - Suzu Kanzaki
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Young Jin Kim
- Department of Radiology, Yonsei University, Shinchon Severance Hospital, Seoul, South Korea
| | - Supika Kritsaneepaiboon
- Department of Radiology, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Thailand
| | - Oktavia Lilyasari
- Department of Cardiology, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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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: 7] [Impact Index Per Article: 1.0] [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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Dijkema EJ, Leiner T, Grotenhuis HB. Diagnosis, imaging and clinical management of aortic coarctation. Heart 2017; 103:1148-1155. [PMID: 28377475 DOI: 10.1136/heartjnl-2017-311173] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/06/2017] [Accepted: 03/15/2017] [Indexed: 12/13/2022] Open
Abstract
Coarctation of the aorta (CoA ) is a well-known congenital heart disease (CHD) , which is often associated with several other cardiac and vascular anomalies, such as bicuspid aortic valve (BAV), ventricular septal defect, patent ductus arteriosus and aortic arch hypoplasia. Despite echocardiographic screening, prenatal diagnosis of C o A remains difficult. Most patients with CoA present in infancy with absent, delayed or reduced femoral pulses, a supine arm-leg blood pressure gradient (> 20 mm Hg), or a murmur due to rapid blood flow across the CoA or associated lesions (BAV). Transthoracic echocardiography is the primary imaging modality for suspected CoA. However, cardiac magnetic resonance imaging is the preferred advanced imaging modality for non-invasive diagnosis and follow-up of CoA. Adequate and timely diagnosis of CoA is crucial for good prognosis, as early treatment is associated with lower risks of long-term morbidity and mortality. Numerous surgical and transcatheter treatment strategies have been reported for CoA. Surgical resection is the treatment of choice in neonates, infants and young children. In older children (> 25 kg) and adults, transcatheter treatment is the treatment of choice. In the current era, patients with CoA continue to have a reduced life expectancy and an increased risk of cardiovascular sequelae later in life, despite adequate relief of the aortic stenosis. Intensive and adequate follow-up of the left ventricular function, valvular function, blood pressure and the anatomy of the heart and the aorta are , therefore, critical in the management of CoA. This review provides an overview of the current state-of-the-art clinical diagnosis, diagnostic imaging algori thms, treatment and follow-up of patients with CoA.
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Affiliation(s)
- Elles J Dijkema
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands
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Shirota G, Maeda E, Namiki Y, Bari R, Ino K, Torigoe R, Abe O. Pediatric 320-row cardiac computed tomography using electrocardiogram-gated model-based full iterative reconstruction. Pediatr Radiol 2017; 47:1463-1470. [PMID: 28667349 PMCID: PMC5608791 DOI: 10.1007/s00247-017-3901-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/05/2017] [Accepted: 05/09/2017] [Indexed: 12/03/2022]
Abstract
BACKGROUND Full iterative reconstruction algorithm is available, but its diagnostic quality in pediatric cardiac CT is unknown. OBJECTIVE To compare the imaging quality of two algorithms, full and hybrid iterative reconstruction, in pediatric cardiac CT. MATERIALS AND METHODS We included 49 children with congenital cardiac anomalies who underwent cardiac CT. We compared quality of images reconstructed using the two algorithms (full and hybrid iterative reconstruction) based on a 3-point scale for the delineation of the following anatomical structures: atrial septum, ventricular septum, right atrium, right ventricle, left atrium, left ventricle, main pulmonary artery, ascending aorta, aortic arch including the patent ductus arteriosus, descending aorta, right coronary artery and left main trunk. We evaluated beam-hardening artifacts from contrast-enhancement material using a 3-point scale, and we evaluated the overall image quality using a 5-point scale. We also compared image noise, signal-to-noise ratio and contrast-to-noise ratio between the algorithms. RESULTS The overall image quality was significantly higher with full iterative reconstruction than with hybrid iterative reconstruction (3.67±0.79 vs. 3.31±0.89, P=0.0072). The evaluation scores for most of the gross structures were higher with full iterative reconstruction than with hybrid iterative reconstruction. There was no significant difference between full and hybrid iterative reconstruction for the presence of beam-hardening artifacts. Image noise was significantly lower in full iterative reconstruction, while signal-to-noise ratio and contrast-to-noise ratio were significantly higher in full iterative reconstruction. CONCLUSION The diagnostic quality was superior in images with cardiac CT reconstructed with electrocardiogram-gated full iterative reconstruction.
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Affiliation(s)
- Go Shirota
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Eriko Maeda
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Yoko Namiki
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Razibul Bari
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Kenji Ino
- Imaging Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Rumiko Torigoe
- Toshiba Medical Systems, 2-1-6, Tsukuda, Chuo-ku, Tokyo, 104-0051 Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
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Li HO, Wang XM, Nie P, Ji XP, Cheng ZP, Chen JH, Xu ZD. Diagnostic Value of Prospective Electrocardiogram-triggered Dual-source Computed Tomography Angiography for Infants and Children with Interrupted Aortic Arch. Chin Med J (Engl) 2016; 128:1184-9. [PMID: 25947401 PMCID: PMC4831545 DOI: 10.4103/0366-6999.156109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Accurate assessment of intra- as well as extra-cardiac malformations and radiation dosage concerns are especially crucial to infants and children with interrupted aortic arch (IAA). The purpose of this study is to investigate the value of prospective electrocardiogram (ECG)-triggered dual-source computed tomography (DSCT) angiography with low-dosage techniques in the diagnosis of IAA. METHODS Thirteen patients with suspected IAA underwent prospective ECG-triggered DSCT scan and transthoracic echocardiography (TTE). Surgery was performed on all the patients. A five-point scale was used to assess image quality. The diagnostic accuracy of DSCT angiography and TTE was compared with the surgical findings as the reference standard. A nonparametric Chi-square test was used for comparative analysis. P <0.05 was considered as a significant difference. The mean effective radiation dose (ED) was calculated. RESULTS Diagnostic DSCT images were obtained for all the patients. Thirteen IAA cases with 60 separate cardiovascular anomalies were confirmed by surgical findings. The diagnostic accuracy of TTE and DSCT for total cardiovascular malformations was 93.7% and 97.9% (P > 0.05), and that for extra-cardiac vascular malformations was 92.3% and 99.0% (P < 0.05), respectively. The mean score of image quality was 3.77 ± 0.83. The mean ED was 0.30 ± 0.04 mSv (range from 0.23 mSv to 0.39 mSv). CONCLUSIONS In infants and children with IAA, prospective ECG-triggered DSCT with low radiation exposure and high diagnostic efficiency has higher accuracy compared to TTE in detection of extra-cardiac vascular anomalies.
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Affiliation(s)
| | - Xi-Ming Wang
- Department of CT, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong 250021, China
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Nance JW, Ringel RE, Fishman EK. Coarctation of the aorta in adolescents and adults: A review of clinical features and CT imaging. J Cardiovasc Comput Tomogr 2015; 10:1-12. [PMID: 26639936 DOI: 10.1016/j.jcct.2015.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/12/2015] [Accepted: 11/10/2015] [Indexed: 01/06/2023]
Abstract
Coarctation of the aorta (CoA), while usually identified and treated in the neonatal/infant period, is increasingly seen in adults, either primarily or (more often) following repair. Imaging plays a crucial role in the diagnosis, therapeutic planning, and follow-up of patients with CoA. Clinical management of CoA in adults optimally involves a multidisciplinary team; accordingly, imagers should be familiar with the underlying pathology, associations, and management of CoA in addition to imaging protocoling and interpretation. We will review the relevant clinical and imaging features of CoA, with an emphasis on patients beyond childhood.
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Affiliation(s)
- John W Nance
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline St, Baltimore, MD, USA
| | - Richard E Ringel
- Department of Pediatrics, Johns Hopkins School of Medicine, 601 N. Caroline St, Baltimore, MD, USA
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline St, Baltimore, MD, USA.
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Nie P, Yang G, Wang X, Duan Y, Xu W, Li H, Cao T, Liu X, Ji X, Cheng Z, Wang A. Application of prospective ECG-gated high-pitch 128-slice dual-source CT angiography in the diagnosis of congenital extracardiac vascular anomalies in infants and children. PLoS One 2014; 9:e115793. [PMID: 25546178 PMCID: PMC4278836 DOI: 10.1371/journal.pone.0115793] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/26/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the value of prospective ECG-gated high-pitch 128-slice dual-source CT (DSCT) angiography in the diagnosis of congenital extracardiac vascular anomalies in infants and children in comparison with transthoracic echocardiography (TTE). METHODS Eighty consecutive infants or children clinically diagnosed of congenital heart disease and suspected with extracardiac vascular anomaly were enrolled, and 75 patients were finally included in this prospective study. All patients underwent prospective ECG-gated high-pitch DSCT angiography after TTE with an interval of 1-7 days. The diagnostic accuracy and sensitivity of high-pitch DSCT angiography and TTE were compared according to the surgical/CCA findings. The image quality of DSCT was assessed using a five-point scale. The effective radiation dose (ED) was calculated. RESULTS A total of 17 congenital heart diseases and 162 separate extracardiac vascular anomalies were confirmed by surgical/CCA findings in 75 patients. The diagnostic accuracy of high-pitch DSCT angiography and TTE was 99.67% and 97.89%, respectively. The sensitivity of high-pitch DSCT angiography and TTE was 97.53% and 79.62%, respectively. There was significant difference regarding to the diagnostic accuracy and the sensitivity between high-pitch DSCT angiography and TTE (χ2 = 23.561 and 28.013, P<0.05). The agreement on the image quality scoring of DSCT between the two observers was excellent (κ = 0.81), and the mean score of image quality was 4.1±0.7. The mean ED of DSCT was 0.29±0.08 mSv. CONCLUSIONS Prospective ECG-gated high-pitch 128-slice DSCT angiography with low radiation dose and high diagnostic accuracy has higher sensitivity compared to TTE in the detection of congenital extracardiac vascular anomalies in infants and children.
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Affiliation(s)
- Pei Nie
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guangjie Yang
- Department of Nuclear Medicine, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Ximing Wang
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
- * E-mail:
| | - Yanhua Duan
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Wenjian Xu
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haiou Li
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Ting Cao
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Xuejun Liu
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaopeng Ji
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Zhaoping Cheng
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Anbiao Wang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Jinan, Shandong, China
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Multidetector computed tomography (MDCT) angiography of thoracic aortic coarctation in pediatric patients: Pre-operative evaluation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2013.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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