Countercurrent aortography: an alternative to cardiac catheterization in infancy

Area of Science:

• Cardiovascular Imaging
• Pediatric Cardiology
• Interventional Radiology

Background:

• Echocardiography and Doppler evaluations can be inconclusive for diagnosing complex aortic arch anomalies in infants.
• Accurate anatomical assessment is critical for managing conditions like aortic coarctation and interrupted aortic arch.

Purpose of the Study:

• To evaluate the diagnostic utility of countercurrent aortography via a peripheral artery in infants with inconclusive cross-sectional and Doppler studies.
• To assess the safety and efficacy of this minimally invasive imaging technique.

Main Methods:

• Countercurrent aortography was performed via a peripheral artery in 25 infants (median age 9 days) with suspected aortic arch anomalies.
• Contrast injection into a right upper limb artery was preferred for optimal visualization of the aortic arch.

Main Results:

• The procedure provided adequate diagnostic information in 24 out of 25 infants.
• Confirmed diagnoses included coarctation of the aorta (15), interrupted aortic arch (2), and vascular ring (1).
• Six infants had anomalies excluded, and only one case (anomalous right subclavian artery origin) was non-diagnostic. Transient arm ischemia occurred in one patient.

Conclusions:

• Countercurrent aortography is a safe and effective minimally invasive alternative to cardiac catheterization for diagnosing aortic arch anomalies in infants with inconclusive echocardiography.
• Peripheral arterial access, particularly via the right upper limb, offers superior visualization of the aortic arch anatomy.