ECHOCARDIOGRAPHY Two - dimensional echocardiographic assessment of the aorta in infants and children with congenital heart disease

To determine the accuracy of two-dimensional echocardiography in the identification of congenital anomalies of the aorta, we compared two-dimensional echocardiographic with angiographic results in 261 consecutive infants and children with congenital heart disease (age 1 day to 20 years, mean 3.3 years). Two-dimensional echocardiography was performed and interpreted without knowledge of angiographic results. Complete visualization of the ascending and descending aorta and aortic arch branches was possible by two-dimensional echocardiographic examination in suprasternal, parasternal, and subcostal views of 255 patients (98%). Identification of the esophagus during swallowing aided the diagnosis of anatomic characteristics of aortic arch. One or more significant aortic arch anomalies were present on angiograms of 116 of 255 patients (46%) and were detected by twodimensional echocardiography in 110 (sensitivity 95%, 99% specificity). Anomalies detected by twodimensional echocardiography/angiography were ascending aorta hypoplasia in four/four, truncus arteriosus three/three, right aortic arch 31/31, anomalous subclavian artery 1 1/16, coarctation 27/29, and patent ductus arteriosus 53/57. We conclude that two-dimensional echocardiography can be used to determine the anatomy of the aorta in most infants and children. In selected patients, two-dimensional echocardiography may eliminate the need for angiographic examination before surgery for congenital heart disease. Circulation 70, No. 3, 417-424, 1984. NONINVASIVE IMAGING of intracardiac anatomy and various forms of congenital heart disease has been possible for several years. However, diagnosis of extracardiac abnormalities has only recently been attempted. Advances in imaging technology make feasible a detailed evaluation of the aorta in newborn infants and children. We therefore examined 261 consecutive children with congenital heart disease by two-dimensional echocardiography. A segmental approach to the aorta was necessary so that it could be visualized completely and this approach was made possible by a combination of parasternal, subcostal, From the Lillie Frank Abercrombie Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, and Texas Children's Hospital, Houston. Address for correspondence: James C. Huhta, M.D., Texas Children's Hospital, 6621 Fannin, Houston, TX 77030. Received Dec. 6, 1983; revision accepted May 17, 1984. Dr. Huhta was supported in part by New Investigator Research award HL31153, by grants HL07190 and RR-05425 from the National Institutes of Health, United States Public Health Service, and by grant RR00188 from General Clinical Research Branch, National Institutes of Health. Presented in part at the meeting of the American College of Cardiology, 1983, New Orleans. Vol. 70, No. 3, September 1984 and suprasternal echocardiographic scans. Findings of two-dimensional echocardiography were compared with those of angiography or at autopsy in an attempt to answer the two following questions: (1) What is the sensitivity of two-dimensional echocardiography in detecting an abnormality of the aorta in infants and children with congenital heart disease? (2) What is the accuracy of two-dimensional echocardiography in diagnosing specific congenital abnormalities of the aorta? Materials and methods Between July 1982 and February 1983, each of 261 neonates, infants, and children underwent prospective two-dimensional echocardiographic examination of the aorta in the pediatric echocardiographic laboratory of Texas Children's Hospital, Houston. Complete examination of the ascending aorta, aortic arch branches, aortic isthmus, and descending aorta was possible in 255 (98%) and in each-the anatomic characteristics of the aorta were confirmed by angiography and/or at autopsy. Of the six patients who were excluded due to incomplete examination results, five were adolescents.'Patients ranged in age from 1 day to 20 years (mean 3.3 years) and there were 157 male and 98 female patients. Ninety-eight patients were less than 1 year of age (42%) and'33 were less than 2 weeks (13%) old. Eighty-two 417 by gest on A ril 9, 2017 http://ciajournals.org/ D ow nladed from