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Echocardiographic assessment of interrupted aortic arch

Published online by Cambridge University Press:  19 August 2008

Renate Kaulitz ,
Richard A. Jonas  and
Mary E. van der Velde
Renate Kaulitz
Affiliation:
Attending physician, Medical School of Hannover, Departments of Cardiology and Cardiovascular Surgery, Children's Hospital, and Departments of Pediatrics and Surgery, Harvard Medical School, Boston, Massachusetts.
Richard A. Jonas
Affiliation:
Professor of Surgery, Departments of Cardiology and Cardiovascular Surgery, Children's Hospital, and Departments of Pediatrics and Surgery, Harvard Medical School, Boston, Massachusetts.
Mary E. van der Velde*
Affiliation:
Assistant Professor of Pediatrics, Departments of Cardiology and Cardiovascular Surgery, Children's Hospital, and Departments of Pediatrics and Surgery, Harvard Medical School, Boston, Massachusetts.
*
Mary E. van der Velde, MD, Department of Cardiology, Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA. Tel: 617–355–6429; Fax: 617–739–6282
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Abstract

Background

In patients with interrupted aortic arch echocardiography provides detailed information about the anatomy of the aortic arch and the associated cardiac anomalies. Only a few reports have evaluated the reliability of this non-invasive diagnostic procedure by correlation with angiographic and surgical findings.

Methods

From 1988 through 1993, 45 infants with interrupted arch underwent surgical repair (mean age 13.02 days). Of the patients, 33 had interruption of the arch between the left common carotid and subclavian arteries; 25 patients had a ventricular septal defect, and the remaining 20 had coexisting complex congenital heart defects. Preoperative diagnosis was made exclusively by echocardiography in 25 of the patients. Accuracy of echocardiographic diagnosis was evaluated retrospectively by comparing preoperative studies with angiography and surgical reports. We then investigated whether the morphologic features of the interrupted arch might influence surgical procedure or outcome.

Results

Intracardiac anatomy was accurately diagnosed by echocardiography in all cases; in 2 patients angiography provided additional information concerning the morphology of the aortic arch. Operative notes described differences in morphology of the arch in 7 patients, but these did not influence the surgical procedure. Direct anastomosis of the interrupted segments was possible in 38 patients, and 36 patients underwent primary intracardiac repair. Echocardiographic measurements revealed that the diameter of the ascending aorta was related to the number of vessels originating from the proximal aortic arch. The distance between the interrupted segments was significantly different according to the site of interruption, but not between cases with an isolated ventricular septal defect versus those with complex heart disease. It did not influence the method of arch repair, nor was it related to recurrent or residual obstruction.

Conclusion

Preoperative echocardiography offers accurate and complete diagnosis in the critically ill neonate with interrupted aortic arch and associated intracardiac abnormalities.

Keywords

Aortic arch anomaliesinterrupted aortic archechocardiography
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 6 , November 1999 , pp. 562 - 571
Copyright
Copyright © Cambridge University Press 1999

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References

1.Qureshi, SA, Maruszewski, B, McKay, R, Arnold, R, West, CA, Hamilton, DI. Determinants of survival following repair of interrupted aortic arch in infancy. Int J Cardiol 1990;26: 303–312.Google Scholar
2.Yeager, SB, Sanders, SP. Echocardiographic identification of thymic tissue in neonates with congenital heart disease. Am Heart J 1995; 129: 837–839.CrossRefGoogle ScholarPubMed
3.Celoria, GC, Patton, RP. Congenital absence of the aortic arch. Am Heart J 1959;58: 407–413.CrossRefGoogle ScholarPubMed
4.Kirklin, JW, Barratt-Boyes, BG (eds). In: Cardiac Surgery. 2nd edition. Churchill Livingstone, New York, 1993. Chapter 1, pp 3–60.Google Scholar
5.Smallhorn, JF, Anderson, RF, McCartney, FJ. Cross–sectional echocardiographic recognition of interruption of aortic arch between left carotid and subclavian arteries. Br Heart J 1982;48: 229–235.CrossRefGoogle ScholarPubMed
6.Gutgesell, HP, Rembold, CM. Growth of the human heart relative to body surface area. Am J Cardiol 1990;65: 662–628.CrossRefGoogle ScholarPubMed
7.Van Praagh, R, Bernhard, WF, Rosenthal, A, Parisi, LF, Fyler, DC. Interrupted aortic arch: surgical treatment. Am J Cardiol 1971;27: 200–211.CrossRefGoogle ScholarPubMed
8.Freedom, RM, Bain, HH, Esplugas, E, Dische, R, Rowe, RD. Ventricular septal defect in interruption of aortic arch. Am J Cardiol 1977;39: 572–582.CrossRefGoogle ScholarPubMed
9.Riggs, TW, Berry, TE, Aziz, KU, Paul, MH. Two-dimensional echocardiographic features of interruption of the aortic arch. Am J Cardiol 1982;50: 1385–1390.CrossRefGoogle ScholarPubMed
10.Schumacher, G, Schreiber, R, Meisner, H, Lorenz, HP, Sebening, F, Buhlmeyer, K. Interrupted aortic arch: natural history and operation results. Pediatr Cardiol 1986;7: 89–93.Google Scholar
11.Menaham, S, Rahayoe, AU, Brawn, WJ, Mee, RBB. Interrupted aotic arch in infancy. A 10–year experience. Pediatr Cardiol 1992;13: 214–221.CrossRefGoogle Scholar
12.Van Mierop, LHS, Kutsche, LM. Cardiovascular anomalies in DiGeorge syndrome and importance of neural crest as a possible pathogenetic factor. Am J Cardiol 1986;58: 133–137.Google Scholar
13.Sell, JE, Jonas, RA, Mayer, JE, Blackstone, EH, Kirklin, JW, Castaneda, AR. The results of a surgical program for interrupted aortic arch. J Thorac Cardiovasc Surg 1988;96: 864–877.CrossRefGoogle ScholarPubMed
14.Fujiwara, K, Yokota, Y, Okamoto, F. Successful surgical repair of truncus arteriosus with interrupted aortic arch in infancy by an anterior approach. Ann Thorac Surg 1988;45: 441–444.CrossRefGoogle ScholarPubMed
15.Irwin, ED, Braunlin, ED, Foker, JE. Staged repair of interrupted aortic arch and ventricular septal defect in infancy. Ann Thorac Surg 1991;52: 632–639.CrossRefGoogle ScholarPubMed
16.Foker, JE. Surgical repair of aortic arch interruption. Ann Thorac Surg 1992;53: 369–370.CrossRefGoogle ScholarPubMed
17.Griffin, S, Richens, D, Behl, R. Early results of direct repair of aortic interruption by the lateral approach. Ann Thorac Surg 1992;53: 430–434.CrossRefGoogle ScholarPubMed
18.Jonas, RA, Quaegebeur, JM, Kirklin, JW, Blackstone, EH, Daicoff, G. Outcomes in patients with interrupted aortic arch and ventricular septal defect. A multiinstitutional study. Congenital Heart Surgeons Society. J Thorac Cardiovasc Surg 1994;107: 1099–1113.CrossRefGoogle ScholarPubMed
19.Huhta, JC, Gutgesell, HP, Latson, LA, Huffines, FD. Two–dimensional echocardiographic assessment of the aorta in infants and children with congenital heart disease. Circulation 1984;70: 417–424.CrossRefGoogle ScholarPubMed
20.Bove, EL, Minich, LL, Prijian, AK, Lupinetti, FM, Snider, AR, Dick, M, Beekman, RH. The management of severe subaortic stenosis, ventricular septal defect, and aortic arch obstruction in the neonate. J Thorac Cardiovasc Surg 1993;105: 289–296.Google Scholar
21.Hanley, FC, Heinemann, MK, Jonas, RA, Mayer, JE, Cook, NR, Wessel, DL, Castaneda, AR. Repair of truncus arteriosus in the neonate. J Thorac Cardiovasc Surg 1993;105: 1047–1056.Google Scholar
22.Karl, TR, Sano, S, Brawn, W, Mee, RBB. Repair of hypoplastic or interrupted aortic arch via sternotomy. J Thorac Cardiovasc Surg 1992;104: 688–695.Google Scholar
23.Radford, DJ, Perkins, L, Lachman, R, Thong, YH. Spectrum of Di George syndrome in patients with truncus arteriosus: Expanded Di George syndrome. Pediatr Cardiol 1988;9: 95–101.CrossRefGoogle ScholarPubMed
24.Clark, EB. Cardiac embryology– its relevance to congenital heart disease. AJDC 1986;140: 41–44.Google ScholarPubMed
25.Jonas, RA, Sell, JE, Van Praagh, R, Parness, I, Blackstone, EH, Mayer, JE, Kirklin, JW, Castaneda, AR. Left ventricular outflow obstruction associated with interrupted aortic arch and ventricular septal defect. In: G, Crupi, L, Parenzan and RH, Anderson (Eds): Perspectives in Pediatric Cardiology. Vol 2. Part 1. Futura Publishing Co., New York, 1989,pp 61–65.Google Scholar
26.Pigott, JD, Chin, AJ, Weinberg, PM, Wagner, HR, Norwood, WJ. Transposition of the great arteries with aortic arch obstruction. J Thorac Cardiovasc Surg 1987;94: 82–86.CrossRefGoogle ScholarPubMed
27.Geva, T, Hornberger, L, Sanders, SP, Jonas, RA, Ott, DA, Colan, SD. Echocardiographic predictors of left ventricular outflow tract obstruction after repair of interrupted aortic arch. J Am Coll Cardiol 1993;22: 1953–1960.Google Scholar
28.Menaham, S, Brawn, WJ, Mee, RBB. Severe subaortic stenosis in interrupted aortic arch in infancy and childhood. J Cardiac Surg 1991;6: 373–380.CrossRefGoogle Scholar
29.Al-Marsafawy, HMF, Ho, SY, Redington, AN, Anderson, RH. The relationship of the outlet septum to the aortic outflow tract in hearts with interruption of the aortic arch. J Thorac Cardiovasc Surg 1995:109: 1225–1236.Google Scholar