Apport du scanner multi-coupe dans les anomalies des arcs et de l'arche aortique chez l'enfant

Congenital malformations of the aortic arches are a heterogeneous group of diseases associated with developmental disorders of the primitive branchial arches during fetal life. The coarctation of the aorta is a common congenital vascular malformation which is a congenital narrowing of the aortic isthmus, a segment of the aorta between the left subclavian artery and the ductus arteriosus. The interruption of the aortic arch is considered by some authors as an extreme coarctation of the aorta, characterized by discontinuity between ascending and descending aorta. These abnormalities are integrated, in most cases, in the context of cardiac malformations from which they are indivisible. CT angiogram plays an essential role in the examination of these abnormalities, their preoperative assessment and their follow-up in the long term. We conducted a retrospective study of 42 patients undergoing CT angiogram following the detection of heart disease on echocardiography. CT angiogram was performed in 6 cases. The average age of patients was 2 years, ranging from 6 days to 14 years; a male predominance was reported with a sex ratio of 1,6. The main diseases were: coarctation of the aorta: 18 cases; hypoplasies of the aortic arch: 8 cases; interruptions of the aortic arch: 7 cases; abnormalities of the aortic arches: 9 cases. Some of these abnormalities were associated. Extracardiac abnormalities associated with congenital heart diseases are relatively frequent; multislice scanner allows for good analysis of the cardiac afferent and efferent pathways. CT complements echocardiogram for pre-treatment assessment of the main malformative diseases, especially for the detection of the associated extra-cardiac vascular abnormalities, thanks to its satisfactory tridimensional multiplanar exploration. It tends to supplant angiography in many pathological malformations for several reasons: it is less invasive; it provides high-resolution 3D images useful to surgeons; it established the anatomical diagnosis, assesses tracheal compression and any associated malformation; it guides surgical treatment.