Echocardiographic assessment of interrupted aortic arch

Background. In patients with interrupted aortic arch echocardiography provi des detailed information about the anatomy of the aortic arch and the assoc iated 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 int errupted arch underwent surgical repair (mean age 13.02 days). Of the patie nts, 33 had interruption of the arch between the left common carotid and su bclavian arteries, 25 patients had a ventricular septal defect, and the rem aining 20 had coexisting complex congenital heart defects. Preoperative dia gnosis was made exclusively by echocardiography in 25 of the patients. Accu racy of echocardiographic diagnosis was evaluated retrospectively by compar ing preoperative studies with angiography and surgical reports. We then inv estigated whether che morphologic features of the interrupted arch might in fluence surgical procedure or outcome. Results: Intracardiac anatomy Tvas a ccurately diagnosed by echocardiography in all cases; in 2 patients angiogr aphy provided additional information concerning the morphology of the aorti c arch. Operative notes described differences in morphology of the arch in 7 patients, but these did not influence the surgical procedure. Direct anas tomosis of the interrupted segments was possible in 38 patients, and 36 pat ients underwent primary intracardiac repair. Echocardiographic measurements revealed that the diameter of the ascending aorta was related to the numbe r of vessels originating from the proximal aortic arch. The distance betwee n the interrupted segments was significantly different according to the sit e of interruption, but not between cases with an isolated ventricular septa l defect versus those with complex heart disease. It did not influence the method of arch repair, nor was it related to recurrent or residual obstruct ion. Conclusion: Preoperative echocardiography offers accurate and complete diagnosis in the critically ill neonate with interrupted aortic arch and a ssociated intracardiac abnormalities.