Aortic aneurysm after patch aortoplasty repair of coarctation: A prospective analysis of prevalence, screening tests and risks

• Published in: Journal of the American College of Cardiology 1989-09, Vol.14 (3), p.734-741
• Main Authors: Bromberg, Burt I., Beekman, Robert H., Rocchini, Albert P., Snider, A.Rebecca, Bank, Estelle R., Heidelberger, Kathleen, Rosenthal, Amnon
• Format: Article
• Language: English
• Subjects: Adolescent; Aortic Aneurysm - diagnosis; Aortic Aneurysm - epidemiology; Aortic Aneurysm - etiology; Aortic Aneurysm - prevention & control; Aortic Coarctation - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Child; Child, Preschool; Diseases of the aorta; Echocardiography; Follow-Up Studies; Humans; Infant; Mass Screening - methods; Medical sciences; Postoperative Complications; Prospective Studies; Risk Factors; Tomography, X-Ray Computed
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(89)90119-8

Twenty-nine children were evaluated prospectively for the presence of an aortic aneurysm at the repair site 1 to 19 years after patch aortoplasty repair of coarctation of the aorta. In each child, noninvasive evaluation included a chest X-ray film, computed tomography of the chest and two-dimensional echocardiography. The presence and size of an aortic aneurysm were determined quantitatively by measuring the ratio of the diameter of the thoracic aorta at the repair site to the diameter of the aorta at the diaphragm (aortic ratio). An aortic ratio of ≥1.5 was judged abnormal and was shown to be significantly greater than the aortic ratio of a normal control group. An aortogram was obtained in each child if any noninvasive screening test was found to be abnormal. As assessed by the aortogram, the prevalence of aortic aneurysm was 24% in this patient group. The sensitivity of echocardiography and chest computed tomography for detecting an aneurysm was 71% and 66%, and the specificity 76% and 85%, respectively. The chest X-ray film was 100% sensitive and 68% specific in determining the presence of an aneurysm. Although the data are not statistically significant, they suggest that children undergoing patch aortoplasty as the primary procedure (rather than a reoperation after earlier resection), and children in whom a Dacron patch is utilized may be at increased risk for aneurysm formation. Thus, in a prospective manner, this study has documented that aortic aneurysm occurs commonly after patch aortoplasty for coarctation in childhood, that the chest X-ray film provides a sensitive screening test and that the aneurysm may be evaluated quantitatively (by measuring the aortic ratio) with echocardiography or chest computed tomography.