Isolated
coarctation of the aorta (
CoA) occurs in 6-8 % of patients with
congenital heart disease. After successful relief of obstruction, patients remain at risk for
aortic aneurysm formation at the site of the repair. We sought to determine the diagnostic utility of echocardiography compared with advanced arch imaging (AAI) in diagnosing
aortic aneurysms in pediatric patients after
CoA repair. The Congenital Heart Databases from 1996 and 2009 were reviewed. All patients treated for
CoA who had AAI defined by cardiac magnetic resonance imaging (MRI), computed tomography (CT), or catheterization were identified. Data collected included the following: type, timing, and number of interventions, presence and time to
aneurysm diagnosis, and mortality. Patients were subdivided into surgical and catheterization groups for analysis. Seven hundred and fifty-nine patients underwent treatment for
CoA during the study period. Three hundred and ninety-nine patients had at least one AAI.
Aneurysms were diagnosed by AAI in 28 of 399 patients at a mean of 10 ± 8.4 years
after treatment. Echocardiography reports were available for 380 of 399 patients with AAI. The sensitivity of echocardiography for detecting
aneurysms was 24 %. The prevalence of
aneurysms was significantly greater in the catheterization group (p < 0.05) compared with the surgery group.
Aneurysm was also diagnosed earlier in the catheterization group compared with the surgery group (p = 0.02). Multivariate analysis showed a significantly increased risk of
aneurysm diagnosis in patients in the catheterization subgroup and in patients requiring more than three procedures.
Aortic aneurysms continue to be an important complication after
CoA repair. Although serial echocardiograms are the test of choice for following-up most congenital cardiac lesions in pediatrics, our data show that echocardiography is inadequate for the detection of
aneurysms after
CoA repair. Because the time to
aneurysm diagnosis was shorter and the risk greater in the catheterization group (particularly for patients requiring more than one procedure), surveillance with cardiac MRI or CT should begin earlier in these patients.