Background: Coarctation of aorta (CoA) is primarily diagnosed using transthoracic echocardiography (TTE). Advanced imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (CMR), are often utilized for surgical planning. However, these procedures carry additional risks of radiation, intravenous contrast, sedation and intubation. We aimed to determine the diagnostic accuracy of TTE compared to advanced imaging for pre-intervention assessment of CoA.

Methods: We performed a 10-year review of children diagnosed with CoA from January 2010 to December 2020. CoA associated with other significant arch anomalies, such as hypoplastic left heart, vascular ring, and interrupted aortic arch, were excluded. Of these, 74 patients had undergone both TTE and advanced imaging prior to their intervention and were included for analysis. Two sets of measurements were made on the TTE and CT/CMR from independent observers. Study data were collected and managed using REDCap electronic data capture tools hosted at University of Arizona using standard statistical tests of significance.

Results: TTE and CT/CMR were performed at an average interval of 11 days. There was no significant difference between ascending aorta and proximal transverse arch measurements obtained by the two modalities. Data did suggest that the aortic isthmus size measured smaller by TTE compared to advanced imaging (p=0.02). TTE had a high accuracy in predicting the coarctation type, arch sidedness, and arch branching pattern. 

Conclusions: The noninvasive modality of TTE appears to be highly accurate for preoperative assessment of simple CoA in most pediatric patients. Advanced imaging, with its associated risks, may be reserved for special circumstances.