![]() To gain access to the suprasternal notch, the patient is positioned supine with a pillow beneath the shoulders to extend the neck without producing tension on the sternocleidomastoid muscles. Suprasternal view is formed when transducer is placed in suprasternal notch and aligned closely and parallel to the sternum. Flow as in (b) may be seen when the patent ductus arteriosus supplies the descending aorta (b) Image showing the normal flow across the descending aorta (for comparison). In the neonatal period, unlike other age groups, there is a significant presence of enlargement of right-sided structures such as right atrium, right ventricle (RV), and pulmonary hypertension with or without LV dysfunction.įigure 2: (a) Image demonstrating the Doppler signal in the descending aorta secondary to severe proximal coarctation of the aorta. Additional clues may be important in the grown-up population to suspect the lesion. Additional suspicion comes from findings commonly associated intracardiac pathologies such as left-sided obstructive lesions, Shone complex, double-outlet LV with subpulmonary ventricular septal defect (VSD) (Taussig Bing anomaly), and muscular VSDs. Markers of significant arch obstruction include features such as left ventricular (LV) dysfunction and LV hypertrophy. Blunted descending aortic Doppler in subcostal imaging and lack of vigorous pulsatile flow in the descending aorta in the subcostal bicaval view are important initial pointers to the presence of coarctation. (b) Image showing color flow across the same demonstrating severe narrowingĮvaluation of suspected aortic arch disease begins with looking for subtle clues to its presence. Only proximal aorta can be images in the parasternal long-axis and short-axis views, and hence, these have limited importance.įigure 1: Two-dimensional echocardiography with color compare in suprasternal long-axis view showing severe discrete coarctation of the aorta after the origin of the left subclavian artery (marked in a). Hence, the grown-up population with limited echocardiography windows may need additional imaging modalities. However, these echocardiography views permit imaging only up to the origin of the first branch and these windows are inadequate in older children and adults. In neonates and infants, subcostal, high parasternal, and even apical views can also provide imaging of the aortic arch. In the grown-up population with limited suprasternal windows, the arch anomalies may be suspected by indirect evidence but generally need additional imaging modalities, such as computed tomography (CT) scan, magnetic resonance imaging (MRI), or conventional angiogram, to profile the lesion.Įchocardiographic Clues in Aortic Arch Evaluationįor the diagnosis of aortic arch anomalies, the most important echocardiography view is the suprasternal view. Less frequently seen is an extreme variant of the above pathology, with luminal discontinuity manifesting as an interrupted aortic arch. Coarctation of the aorta and its severest form, i.e., interrupted aortic archĮchocardiography is particularly diagnostic in the pediatric population, for the most frequently encountered arch disease – coarctation of the aorta.Anomalies of the aortic arch may be classified based on the following: Clinical assessment with echocardiographic evaluation is the most accessible initial tool to suspect aortic arch anomaly. ![]() Available from: Įchocardiography is the diagnostic modality of choice in the initial evaluation and planning for the management of aortic arch anomalies. J Indian Acad Echocardiogr Cardiovasc Imaging 2022 6:209-15. Echocardiography in Planning Aortic Arch Interventions. How to cite this URL: Awasthy N, Bhatt A, Kumar G. J Indian Acad Echocardiogr Cardiovasc Imaging 2022 6:209-15 How to cite this article: Awasthy N, Bhatt A, Kumar G. Keywords: Arch anomalies, arch interruption, coarctation, echocardiography This review provides an overview of the role of echocardiography in planning aortic arch interventions. may serve as indirect markers of the arch lesion. Suprasternal and subcoastal views are particularly important for evaluation, although other indirect parameters such as pressure effects (ventricular hypertrophy) and ventricular dysfunction etc. ![]() Most of the interevntions are however planned on the basis of echocardiography. Aortic arch anomalies are suspected on echocardiography, though the final diagnosis may need additional investigative modalities such as cardiac catheterization, computed tomography angiography or rarely magnetic resonance imaging.
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