Rose-Felker Kirsten, Robinson Joshua D, Backer Carl L, Rigsby Cynthia K, Eltayeb Osama M, Mongé Michael C, Rychlik Karen, Sammet Christina L, Gossett Jeffrey G
1 Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
2 Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
World J Pediatr Congenit Heart Surg. 2017 Mar;8(2):196-202. doi: 10.1177/2150135116683929.
Computed tomographic angiography (CTA) and echocardiography (echo) are used preoperatively in coarctation of the aorta to define arch hypoplasia and great vessel branching. We sought to determine differences in quantitative measurements, as well as surgical utility, between modalities.
Infants (less than six months) with both CTA and echo prior to coarctation repair from 2004 to 2013 were included. Measurements were compared and correlated with surgical approach. Three surgeons reviewed de-identified images to predict approach and characterize utility. Computed tomographic angiography radiation dose was calculated.
Thirty-three patients were included. No differences existed in arch measurements between echo and CTA ( z-score: -2.59 vs -2.43; P = .47). No differences between modalities were seen for thoracotomy ( z-score: -2.48 [echo] vs -2.31 [CTA]; P = .48) or sternotomy ( z-score: -3.13 [echo] vs -3.08 [CTA]; P = .84). Computed tomographic angiography delineated great vessel branching pattern in two patients with equivocal echo findings ( P = .60). Surgeons rated CTA as far more useful than echo in understanding arch hypoplasia and great vessel branching in cases where CTA was done to resolve anatomical questions that remain after echo evaluation. Two of three surgeons were more likely to choose the surgical approach taken based on CTA (surgeon A, P = .02; surgeon B, P = .01). Radiation dose averaged 2.5 (1.6) mSv and trended down from 2.9 mSv (1.8 mSv; n = 20) to 1.6 mSv (0.5 mSv; n = 7) ( P = .06) with new technology.
Although CTA and echo measurements of the aorta do not differ, CTA better delineates branching and surgeons strongly prefer it for three-dimensional arch anatomy. We recommend CTA for patients with anomalous arch branching patterns, diffuse or complex hypoplasia, or unusual arch morphology not fully elucidated by echo.
计算机断层血管造影（CTA）和超声心动图（echo）术前用于主动脉缩窄，以确定主动脉弓发育不全和大血管分支情况。我们试图确定这两种检查方式在定量测量以及手术应用方面的差异。
纳入2004年至2013年在主动脉缩窄修复术前同时接受CTA和echo检查的婴儿（小于6个月）。对测量结果进行比较，并与手术方式相关联。三位外科医生查看去识别信息的图像以预测手术方式并描述其应用价值。计算CTA的辐射剂量。
共纳入33例患者。echo和CTA在主动脉弓测量方面无差异（z值：-2.59对-2.43；P = 0.47）。在开胸手术（z值：-2.48 [echo]对-2.31 [CTA]；P = 0.48）或胸骨切开术（z值：-3.13 [echo]对-3.08 [CTA]；P = 0.84）方面，两种检查方式也无差异。CTA明确了两名echo检查结果不明确患者的大血管分支模式（P = 0.60）。在CTA用于解决echo评估后仍存在的解剖学问题的病例中，外科医生认为CTA在理解主动脉弓发育不全和大血管分支方面比echo有用得多。三位外科医生中有两位更有可能根据CTA选择手术方式（外科医生A，P = 0.02；外科医生B，P = 0.01）。新技术使辐射剂量平均为2.5（1.6）mSv，并呈下降趋势，从2.9 mSv（1.8 mSv；n = 20）降至1.6 mSv（0.5 mSv；n = 7）（P = 0.06）。
虽然CTA和echo对主动脉的测量结果无差异，但CTA能更好地显示分支情况，且外科医生强烈倾向于用它来了解三维主动脉弓解剖结构。对于主动脉弓分支模式异常、弥漫性或复杂性发育不全或echo未完全阐明的异常主动脉弓形态的患者，我们推荐使用CTA。
