Management of coarotation of the Aorta; the use of multi-slice CT Scan in case selection

ABSTRACT

Treatment options for native coarctation of the aorta [CoA] are catheter-based intervention [balloon angioplasty with or without stenting] or surgical repair. Selection of the appropriate treatment modality is crucial for safe management and is dictated by several factors including aortic anatomy and CoA morphology. Assessment of these factors is most commonly achieved using echocatfiography coupled with either conventional angiography or magnetic resonance angiography. Multidetector computed tomography [MDCT] or multi-slice CT scan, although commonly used for diagnosis and follow-up of CoA following definitive treatment, has not been previously evaluated as a tool for deciding the optimal treatment modality. Aim is to evaluate employment of MDCT for selection of the appropriate treatment modality in patients with native CoA. Between May 2004 and June 2007, 17 patients with a mean age of 10 years [1 month-16 years] were referred for management of echocardiographically- documented isolated native CoA. MDCT scans of the heart and aorta were obtained in all patients using a 16-row CT scanner. The choice of definitive management strategy, whether catheter-based or surgical, was decided based on aortic anatomy and CoA morphology depicted in the MDCT images. Four of the 17 patients included in the study were deemed unsuitable for catheter-based intervention based on the MDCT images. Of the four patients, one had dense annular calcification of the proximal descending aorta, two had aneurysms of the ascending or descending aorta related to the CoA site and one had a hypoplastic aortic arch. Findings were confirmed at surgery. Surgeries were successful and uncomplicated. Balloon angioplasty with/without stent placement was performed in the remaining 13 patients. In this group, the peak systolic gradient decreased from a mean of 77mmHg to a mean of 7mmHg and the CoA site diameter increased from a mean of 2.4mm to a mean of 13mm. There were no complications. MDCT readily delineates aortic and CoA site anatomic and morphologic features that may negate catheter-based intervention in favor of surgical repair. This may help avoid complications and enhance successful and safe management of patient, whether infants, children or adolescents with native CoA