Comparison of Echocardiography and Computed Tomography Angiography in the Evaluation of Pulmonary Arteries and Pulmonary Annulus in Congenital Heart Diseases with Right Ventricular Outflow Tract Obstruction

Abstract

Background: Congenital heart diseases (CHDs) are the most commonly occurring birth defects. Clinically significant CHD necessitates percutaneous or operative intervention early in life. Accurate knowledge of the morphology and caliber of the pulmonary arteries and pulmonary valve is important in surgical planning, postoperative complications, and long-term outcome of various CHDs. This study aimed to compare echocardiography and computed tomography angiography (CTA) in the evaluation of the pulmonary arteries and pulmonary annulus in children with cyanotic CHD with right ventricular outflow obstruction. Materials and Methods: Our study was a cross-sectional study involving 39 children under the age of 2 years with diagnosed cyanotic CHD. Spectrum included were tetralogy of Fallot (TOF), TOF with pulmonary atresia, double-outlet right ventricle-TOF type, pulmonary atresia, and pulmonary stenosis. All patients underwent transthoracic echocardiography, followed by CTA. Images were reconstructed and analyzed, and the results were compared with echocardiography. Results: There was a good correlation between echocardiography and CTA in the evaluation of the caliber of pulmonary arteries and pulmonary valve, with a Pearson’s correlation coefficient of 0.85, 0.69, 0.62, and 0.73 for the main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), and pulmonary valve, respectively. There was an underestimation of the caliber of the main, right, and left pulmonary arteries with echocardiography (with a bias of 0.73 ± 1.96 mm, 0.01 ± 2.3 mm, and 0.17 ± 1.3 mm for the MPA, RPA, and LPA, respectively) and overestimation of the caliber of the pulmonary annulus (with a bias of −0.07 ± 2.20 mm). Conclusions: Despite a good correlation and agreement in the measurement of vessel diameters, echocardiography may misdiagnose certain cases of valvular or arterial stenosis as atresia, or may fail to visualize the structures entirely. In such patients, further evaluation with CTA may be required.