Validity of MSCT Angiography in Guiding Selection of the Appropriate Treatment Modality in Patients with Coarctation of the Thoracic Aorta

Introduction: Treatment options for coarctation of the aorta (CoA) are catheter-based intervention (balloon angioplasty with or without stenting) or surgical repair. Selection of the appropriate treatment modality is crucial for safe management and is dictated by several factors including aortic anatomy and CoA morphology. Assessment of these factors is most commonly achieved using echocardiography coupled with either conventional angiography or magnetic resonance angiography. Multidetector computed tomography (MDCT), although commonly used for diagnosis and follow-up of CoA following definitive treatment, has not been previously evaluated as a tool for deciding the optimal treatment modality. Aim: To evaluate employment of MDCT for selection of the appropriate treatment modality in patients with native CoA. Methods: Between January 2013 and December 2014, 25 patients (15 males and 10 females) with a mean age of 15 years (1 month-45 years) were referred for management of echo cardiographic ally documented isolated native CoA. MDCT scans of the heart and aorta were obtained in all patients using a 16-row CT scanner. The choice of definitive management strategy, whether catheter-based or surgical, was decided based on aortic anatomy and CoA morphology depicted in the MDCT images. Results: Four of the 25 patients included in the study were deemed unsuitable for catheter-based intervention based on the MDCT images. Of the four patients, one had dense annular calcification of the proximal descending aorta, two had aneurysms of the ascending or descending aorta related to the CoA site and the fourth had a hypoplastic aortic arch. Findings were confirmed at surgery. Surgeries were successful and uncomplicated. Balloon angioplasty with/without stent placement was performed in the remaining 16 patients. In this group, the peak systolic gradient decreased from a mean of 77mmHg to a mean of 7mmHg and the CoA site diameter increased from a mean of 2.4mm to a mean of 13mm. There were no complications. Conclusion: MDCT readily delineates aortic and CoA site anatomic and morphologic features that may negate catheter-based intervention in favor of surgical repair. This may help avoid complications and enhance successful and safe management of patients with native CoA.