ABSTRACT
Objective: Diagnosis of Aortic arch (AoA) anatomy is critical for
planning cardiac surgery/intervention and in diagnosing associated
congenital heart defects. AoA sidedness is traditionally diagnosed with
echocardiography as being contralateral to the direction of the first
brachiocephalic artery in suprasternal view, but this method can be
challenged by numerous anatomic variants and clinical conditions. The
objective of this study was to assess feasibility of trachea
visualization with echocardiography in pediatric patients, and using
this landmark to identify AoA sidedness and potential for double aortic
arch (DAA).
Methods: A prospective study was performed on patients <18
years old who were undergoing Chest CT/MRI to serve as gold standard for
confirming AoA anatomy. A right-to-left echocardiographic sagittal sweep
was performed from the suprasternal notch and used to categorize 1) Left
AoA = right SVC-trachea-AoA, 2) Right AoA= SVC-AoA-trachea, 3) DAA =
SVC-AoA-trachea-AoA. The proportion of successful sweeps and diagnostic
accuracy were calculated.
Results: 100 consecutive patients were scanned (44% female; median age
of 8.8 yr, range 2dā17.9 yr; median BSA 1.14 m2,
range 0.2ā2.7; right AOA in 4%). Diagnosis of AoA sidedness was
possible in 97% (95% CI: 94ā100%, p < 0.01) and correct in
100% when the trachea was seen.
Conclusion: Tracheal imaging with echo is reliable, easy, and
reproducible method in patients of various sizes and levels of acuity to
define AoA sidedness.