title: Does the z-score value of the abdominal aorta predict recoarctation in an infant?
abstract: OBJECTIVE
  We evaluated left ventricular dimensions and aortic arch z-scores in infants who underwent balloon angioplasty (BAP) or surgery for coarctation of aorta (CoA). We searched for risk factors predicting recoarctation.
  
  
  METHODS
  Between 2007-2011, 27 male and 17 female infants (mean age 2.93 ± 4.78 months, range 2 days-24 months) with CoA were evaluated. Left ventricular dimensions, systolic functions, mitral and aortic annuli, transverse aortic arch, isthmus, coarctation site, and diaphragmatic aorta measurements were done and z-scores were determined before intervention.
  
  
  RESULTS
  Six patients underwent primary operation, 38 patients had BAP (86.4%). Associated cardiac pathologies in operated patients were double outlet right ventricle (n = 2), atrioventricular septal defect (n = 1), Ebstein's anomaly (n = 1), arch hypoplasia (n = 2). Twelve patients (27.2%) had simple coarctation. Ventricular septal defect was the most frequent associated cardiac pathology (n = 20, 45.4%). The patients were followed for 10.22 ± 8.21 months. Among 33 primary successful BAP's, 14 had recoarctation (42%). Eleven patients were primarily operated (including 5 with unsuccessful BAP), two had recoarctation (18%). Abdominal and transverse aorta values and z-scores were significantly lower in the recoarctation group (7.15 ± 2.12 mm and 6.07 ± 1.86 mm respectively in the "no-recoarctation group"; vs. 5.53 ± 0.75 mm and 4.94 ± 1.53 mm in the "recoarctation group" P <.05). Abdominal aorta z-score of 0.42 was 88.9% sensitive and 53.8% specific to predict recoarctation (area under ROC curve: 0.618-0.902, P <.05).
  
  
  CONCLUSIONS
  Although BAP for native coarctation is still a controversial treatment option due to frequent restenosis rates, abdominal aorta z-score of 0.42 could correctly eliminate recoarctation in 89% of these cases. This cutoff value might help us choose patients for primary BAP and decrease the recoarctation rate after BAP.
authors: Başkent University İstanbul Research Hospital, İstanbul, Turkey. cayabakan@yahoo.com
authors: Canan
authors: C
authors: Ayabakan
authors: Köksal
authors: K
authors: Binnetoğlu
authors: Özlem
authors: Ö
authors: Sarisoy
authors: Kürşad
authors: K
authors: Tokel
mesh_terms: D000015:Abnormalities, Multiple; D000367:Age Factors; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D001012:Aorta, Abdominal / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D001013:Aorta, Thoracic / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D002675:Child, Preschool; D003661:Decision Support Techniques; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018579:Patient Selection; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D016277:Ventricular Function, Left
keywords: Balloon Angioplasty; Infant; Recoarctation