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To evaluate the value of echocardiography in diagnosis of different types of Interrupted aortic artery (IAA)
We report our institutional (one of top10 largest institution in china) experience and correlated echocardiography diagnosis with surgical and angiographic findings. From July 2006 to September 2014, 40 patients were diagnosed with IAA. Of the patients, 31 underwent surgical repair and 27 had angiography. Preoperative diagnosis was made exclusively by echocardiography. Accuracy of echocardiographic diagnosis was evaluated retrospectively by comparing preoperative studies with angiography and surgical reports. We then investigated whether echocardiographic diagnosis of IAA type and co-existing cardiac defects might influence the timing of initial operation and type of surgical procedures.
Using Celoria and Patton classification system for IAA, type A was seen in 65% (26/40) of patients (likely most common in Chinese population), type B was seen in 32.5% (13/40) (reported most common in literature) and type C was seen in 2.5% (1/40). Our accuracy rate for IAA type was 82.5%, which was confirmed by operative notes and angiographic reports. The accuracy of echocardiography in diagnosing the associated cardiac malformation was 99%. Twelve associated cardiac malformation were found in these patients. The patent ductus arteriosus (97.5%) and ventricular septal defect (85%) are most commonly associated with simple IAA. Other cardiovascular abnormalities were seen including atrial septal defect or patent foramen ovale (50%), aortopulmonary septal defect (10%), anomalous origin of right pulmonary artery from the ascending aorta (7.5%), double-outlet right ventricle (7.5%), transposition of the great arteries (5%), truncus arteriosus (5%), aortic valvular malformation (2.5%), cor triatriatum (2.5%), stenosis of right upper pulmonary vein inlet (2.5%) and anomalous origin of the left circumflex artery from the right coronary sinus (2.5%). One adult patient with type A IAA doesn’t have any intracardiac malformation. Five patients were misdiagnosed as coarctation of aorta, one missed case was associated with truncus arteriosus, and another missed was an adult without intracardiac malformation, but these did not influence the surgical procedure and outcome. Echocardiographic measurements of diameter of the ascending aorta, distance between the interrupted segments and associated cardiovascular defects had great influence on the methods of surgical repair. Intracardiac abnormalities were accurately diagnosed by echocardiography in almost all cases except one with missing anomalous origin of the left circumflex artery from the right coronary sinus.
Echocardiography can accurately diagnose and characterize the various forms of IAA and associated intracardiac defects for preoperative surgical decision making.