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(Circulation. 1999;99:3086-3087.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Three-Dimensional Visualization of Recurrent Coarctation of the Aorta by Electron-Beam Tomography and MRI

Paul T. Pitlick, MD; Courtney L. Anthony, MD; Phillip Moore, MD; Roger Y. Shifrin, MD; Geoffrey D. Rubin, MD

From the Departments of Pediatrics (P.T.P.) and Diagnostic Radiology (R.Y.S., G.D.R.), Stanford University School of Medicine; the Department of Pediatrics, California-Pacific Medical Center (C.L.A.); the Department of Pediatrics, University of California, San Francisco (P.M.); and The Lucile Salter Packard Children's Hospital.

Correspondence to Paul T. Pitlick, MD, Department of Pediatrics, Stanford University School of Medicine, 750 Welch Rd, Suite 305, Palo Alto, CA 94304.

The patient was a 12-year-old boy who was born with a coarctation of the thoracic aorta. He underwent a Gore-Tex patch angioplasty of the coarctation at 13 days of age. Subsequent restenosis led to subclavian flap angioplasty at age 7 months. He presented now with upper extremity hypertension and decreased femoral pulses.

Attempted visualization of the aortic isthmus by cross-sectional echocardiography was inadequate. The family was initially reluctant to consent to a cardiac catheterization. After 3-dimensional (3D) reconstruction of electron-beam tomography (EBT) and MRI (Figures 1 and 2), the pathological condition was more fully appreciated. The patient then underwent cardiac catheterization, angiography (Figure 3), and balloon angioplasty of the recurrent coarctation.

View larger version (52K): [in this window] [in a new window]   Figure 1. Shaded-surface reconstruction of aortic arch, innominate vein, and pulmonary arteries from EBT. Blocks in lower left-hand corners show orientation. A indicates anterior; H, head; L, left; R, right; P, posterior; AAo, ascending aorta; AoI, aortic isthmus; DAo, descending aorta; IA, innominate artery; IV, innominate vein; LCC, left common carotid; LPA, left pulmonary artery; LSA, left subclavian artery; LV, left ventricle; MPA, main pulmonary artery; RPA, right pulmonary artery; RV, right ventricle; SVC, superior vena cava; and VA, vertebral artery. Top, View from left, front, and slightly cephalad. A web is suggested along upper surface of aortic isthmus (arrow), possibly because previous operations were from left thoracotomies, and this would be region of operation. Aorta below coarctation site is aneurysmal. Bottom, View from right, posterior, slightly cephalad. A web is well-defined here (arrow). Please see the . . . [Full Text of this Article]