Transverse aortic arch to descending aorta ratio: a new echocardiographic parameter for management of coarctation of the aorta in the infant.

OBJECTIVE

The purpose of this study was to establish an objective criterion to help assess adequacy of the transverse arch in newborns with coarctation and thereby optimize preoperative surgical decision making.

METHODS

Echocardiograms of 47 patients < 6 months of age who underwent coarctation repair from September 2005 to November 2008 and 47 age-matched healthy infants were reviewed. The proximal and distal transverse aortic arch to descending aorta ratios (TAA:DAO ratio) were calculated from the end-systolic proximal and distal transverse aortic arch diameters and diameter of the descending aorta at the diaphragm.

RESULTS

Both the proximal and distal TAA:DAO ratios were significantly lower in the study vs. control group (P = .001) and in patients who underwent patch reconstruction of the aorta vs. extended end-to-end anastomosis (P = .014; P = .015). All patients who underwent patch reconstruction had a proximal and/or distal TAA:DAO < 0.65. A cutoff of 0.65 was derived based on our analyses and an algorithm was developed to guide decision making. Forty-six out of 47 patients were free from reintervention.

CONCLUSION

The TAA:DAO ratio appears to be an accurate parameter by which the adequacy of the transverse arch can be assessed preoperatively using the proposed algorithm, and thus help determine the type of surgical intervention and approach.