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The Usefulness of Computed Tomography in Predicting Left Ventricular Outflow Tract Obstruction After Neonatal Arch Repair

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Abstract
This study investigated the outcome after neonatal arch repair, and the usefulness of computed tomography (CT) in predicting the development of left ventricular outflow tract (LVOT) obstruction (LVOTO). A total of 150 neonates who underwent arch repair between 2008 and 2019 were included. The diameters of the aortic valve annulus (AVA) and LVOT in millimeters were measured with transthoracic echocardiography (TTE) or CT and indexed by subtracting body weight in kilograms. The outcomes of interest were the development of LVOTO (peak flow velocity > 3 m/s on TTE) and reintervention or reoperation for LVOTO. The median follow-up duration was 3.6 years. The rates of overall survival, freedom from reintervention for LVOTO, and freedom from the LVOTO development at 7 years were 93.7%, 88.2%, and 81.0%, respectively. In univariable Cox regression analysis, weight-indexed CT-measured LVOT diameter (concordance index [C-index] = 0.73, P = 0.002) and weight-indexed TTE-measured AVA diameter (C-index = 0.69, P = 0.001) were significant predictors of LVOTO. The maximal chi-square test identified the following cutoff values for predicting LVOTO: 1.4 for weight-indexed CT-measured LVOT diameter and 1.6 for weight-indexed TTE-measured AVA diameter. The high-risk group (both measures lower than the cutoff values) had a significantly lower rate of freedom from LVOTO development than the low-risk group (both measures higher than the cutoff values) (P < 0.001). The weight-indexed CT-measured LVOT diameter could be used to predict LVOTO development after neonatal arch repair, as an independent measure or complementary to traditional measures.
Issued Date
2023
Dong-Hee Kim
Eun Seok Choi
Bo Sang Kwon
Tae-Jin Yun
Dong Hyun Yang
Chun Soo Park
Type
Article
Keyword
Arch obstructionCoarctation of aortaComputed tomographyInterrupted aortic archLeft ventricular outflow tract obstruction
DOI
10.1053/j.semtcvs.2021.12.017
URI
https://oak.ulsan.ac.kr/handle/2021.oak/17457
Publisher
SEMINARS IN THORACIC AND CARDIOVASCULAR SURGERY
Language
영어
ISSN
1043-0679
Citation Volume
35
Citation Number
1
Citation Start Page
127
Citation End Page
137
Appears in Collections:
Medicine > Nursing
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