Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Rajaie Cardiovascular Medical and Research Center, Iran Medical University of Medical Sciences, Valiasr Ave Niayesh Intersection, Tehran, Iran.
Pediatr Cardiol. 2021 Feb;42(2):442-450. doi: 10.1007/s00246-020-02503-y. Epub 2021 Jan 4.
Intravascular ultrasound (IVUS) has been introduced as an accurate and minimally invasive diagnostic technique for the assessment of vascular anatomy and its abnormalities. We believe that IVUS can be used for clarifying the reasons for failure of balloon angiography in infantile coarctation of the aorta (CoA), because post-balloon angioplasty tearing, intimal flap, thrombosis and pseudoaneurysm of the aorta can be evaluated by IVUS with greater sensitivity and specificity. We aimed to assess the outcome of balloon angioplasty of CoA using angiography as the gold standard and IVUS as a new method in infants, comparing the two techniques for the evaluation of the diameter and area of CoA segment pre- and post-procedure. This cross-sectional study was performed on 18 infants hospitalized with a final diagnosis of CoA. All the infants underwent angiography and were also assessed by IVUS to measure the preoperative and postoperative diameter of the narrow segment in the two anterior-posterior and lateral views. In assessment by IVUS, the mean diameter of the coarctation site increased from 2.10 ± 0.30 mm to 4.50 ± 0.94 mm (P < 0.001). Similarly, the average minimum area of the coarctation level increased from 5.26 ± 1.50 mm to 13.77 ± 3.48 mm after angioplasty (P < 0.001). Comparing these findings, angiography and IVUS showed a high level of agreement. In the assessment of a dissection flap, there was a high level of agreement between angioplasty and IVUS before the procedure, but IVUS had higher accuracy after the procedure. Our study showed that IVUS was more reliable than angiography in the assessment of residual coarctation. IVUS yielded high sensitivity (58.3%) and specificity (100%) for discriminating the presence and absence of residual coarctation as well as the need for repeating the procedure. The assessment of coarctation before and after angioplasty procedures in children is possible using the IVUS method, with high accuracy. IVUS can offer greater accuracy than angiography in the evaluation of the coarctation area, detecting tears, dissection and flaps, and assessment of residual coarctation.
血管内超声（IVUS）已被引入作为一种准确且微创的诊断技术，用于评估血管解剖及其异常。我们认为，IVUS 可用于阐明婴儿主动脉缩窄（CoA）球囊血管成形术失败的原因，因为 IVUS 可以更敏感和更特异地评估球囊血管成形术后的撕裂、内膜瓣、血栓形成和主动脉假性动脉瘤。我们旨在评估血管造影作为金标准和 IVUS 作为一种新方法在婴儿中的应用，比较两种技术评估 CoA 段术前和术后的直径和面积。这项横断面研究纳入了 18 例因最终诊断为 CoA 住院的婴儿。所有婴儿均接受了血管造影检查，并通过 IVUS 评估，以测量前后位和侧位两个视图中狭窄段的术前和术后直径。IVUS 评估显示，缩窄部位的平均直径从 2.10±0.30 毫米增加到 4.50±0.94 毫米（P<0.001）。同样，缩窄部位的平均最小面积从 5.26±1.50 毫米增加到血管成形术后的 13.77±3.48 毫米（P<0.001）。比较这些发现，血管造影和 IVUS 显示出高度的一致性。在评估夹层瓣时，在术前，血管造影和 IVUS 之间具有高度的一致性，但在术后，IVUS 具有更高的准确性。我们的研究表明，在评估残余缩窄方面，IVUS 比血管造影更可靠。IVUS 对区分残余缩窄的存在和不存在以及是否需要重复手术的诊断具有较高的敏感性（58.3%）和特异性（100%）。使用 IVUS 方法可以对儿童的缩窄进行术前和术后评估，具有较高的准确性。IVUS 可以比血管造影术更准确地评估缩窄区域，检测撕裂、夹层和瓣，以及评估残余缩窄。
