Morphological characterisation of ventricular septal defects associated with coarctation of aorta by cross-sectional echocardiography
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In infants with coarctation of the aorta and ventricular septal defect, echocardiograms reveal common defect types and abnormal valve insertions. These findings often direct left ventricular blood flow toward the pulmonary artery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Coarctation of the aorta (CoA) and ventricular septal defect (VSD) are significant congenital heart defects.
- Understanding the complex interplay and anatomical variations in these combined defects is crucial for surgical planning.
Purpose of the Study:
- To retrospectively assess the anatomical characteristics of VSDs in neonates and infants with coarctation of the aorta.
- To correlate VSD morphology with associated left ventricular outflow tract abnormalities and aortic override.
Main Methods:
- Retrospective analysis of cross-sectional echocardiograms from 18 neonates and infants.
- Utilized subcostal and precordial views to determine VSD site and anatomical relationships.
- Evaluated for associated anomalies including aortic override and tricuspid valve insertion.
Main Results:
- Perimembranous VSDs were most common (12/18), often with aortic override and left ventricular outflow tract narrowing.
- Other VSD types included muscular trabecular, malalignment, and doubly committed subarterial defects.
- Abnormal tricuspid valve insertion was noted in 10 cases, partially obscuring the VSD.
Conclusions:
- The morphology of VSDs in conjunction with coarctation of the aorta frequently leads to abnormal left ventricular ejection patterns.
- Left ventricular outflow is often directed towards the pulmonary artery due to the specific anatomical configurations observed.
Abstract:
Cross-sectional echocardiograms of 18 neonates and infants with coarctation of the aorta and ventricular septal defect were retrospectively assessed. With a combination of subcostal and precordial cuts the site and anatomical relations of the defects were determined. In one case there was a muscular trabecular ventricular septal defect. Three had a malalignment defect with associated left ventricular outflow tract obstruction. In two there was a doubly committed subarterial defect with associated malalignment of the point of continuity between the aortic and pulmonary valves and the crest of the trabecular septum. Twelve cases had a perimembranous defect, with varying degrees of extension into the inlet, trabecular, or outlet septum. In this group 10 had associated aortic override, with varying degrees of left ventricular outflow tract narrowing. Abnormal insertion of the tricuspid valve was observed in 10 cases, such that it partly obscured the ventricular septal defect. Thus in most cases of coarctation with ventricular septal defect, the morphology of the ventricular septal defect and ventricular outflow tracts is such that left ventricular ejection is directed towards the pulmonary artery rather than the aorta.