{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T20:39:05Z","timestamp":1786653545301,"version":"build-2736575974"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Aortic coarctation is a congenital heart disease characterized by narrowing of the distal aortic arch or isthmus. Its management relies on arterial hypertension, stenosis severity, and peak-to-peak gradients. Despite various assessment methods, there is limited discussion on measuring stenosis using computed tomography\u00a0(CT)\u00a0angiography and its correlation with clinical, echocardiographic, and invasive gradients, as well as surgical or endovascular indications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      This retrospective study included 129\u00a0patients with aortic coarctation or recoarctation who underwent clinical, echocardiographic, catheterization, and CT angiography. Patients with mid-arch hypoplasia and patent ductus arteriosus were excluded from the study. CT angiography was used, and detailed measurements of the aortic isthmus and diaphragmatic aorta were performed, including isthmus-to-diaphragm ratios, body surface area-indexed measurements, and\n                      <jats:italic toggle=\"yes\">z<\/jats:italic>\n                      -scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Multiple parameters presented moderate-to-high correlation with echocardiographic and invasive gradients. The best discriminator for significant invasive gradient\u00a0(&gt;20\u00a0mmHg) was the hydraulic diameter Pediatric Heart Network\n                      <jats:italic toggle=\"yes\">z<\/jats:italic>\n                      -score\u00a0(area under the receiver operating characteristic curve\u00a0=\u00a00.869), and the best predictor for intervention was the minimum diameter Detroit z-score\u00a0(\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). The isthmus-to-diaphragm area ratio presented good diagnostic accuracy\u00a0(area under the receiver operating characteristic curve\u00a0=\u00a00.814), with an optimal cutoff of 0.73 for a significant invasive gradient. Interobserver reliability was high\u00a0(&gt;0.9) for all measurements.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>CT angiography-derived isthmus-to-diaphragmatic area ratio is a simple, accurate, and reliable assessment of aortic coarctation and recoarctation severity. These findings support its use in clinical decision-making and suggest potential for standardized protocols.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/apc.apc_221_24","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T08:00:15Z","timestamp":1752480015000},"page":"19-25","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["CT angiography versus clinical, echocardiographic, and invasive gradients in coarctation and recoarctation of the aorta"],"prefix":"10.4103","volume":"18","author":[{"given":"Andr\u00e9","family":"Vaz","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Radiology, Heart Institute, Clinics Hospital, Faculty of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludmila M.","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Radiology, Heart Institute, Clinics Hospital, Faculty of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata Muller","family":"Couto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Radiology, Heart Institute, Clinics Hospital, Faculty of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin R. M.","family":"de Paula","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Radiology, Heart Institute, Clinics Hospital, Faculty of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo K. U. N.","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Radiology, Heart Institute, Clinics Hospital, Faculty of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7,14]]},"reference":[{"key":"R1-20260421","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1093\/eurheartj\/ehaa554","article-title":"2020 ESC guidelines for the management of adult congenital heart disease: The task force for the management of adult congenital heart disease of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Adult Congenital Heart Disease (ISACHD)","volume":"42","author":"Baumgartner","year":"2021","journal-title":"Eur Heart J"},{"key":"R2-20260421","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1017\/S1047951116001955","article-title":"Guidelines for the management of congenital heart diseases in childhood and adolescence","volume":"27","author":"Haas","year":"2017","journal-title":"Cardiol Young"},{"key":"R3-20260421","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1016\/j.jtcvs.2011.02.048","article-title":"Prediction of recurrent coarctation by early postoperative blood pressure gradient","volume":"142","author":"Kumar","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"R4-20260421","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.hlc.2013.10.055","article-title":"Detection of serious complications by MR imaging in asymptomatic young adults with repaired coarctation of the aorta","volume":"23","author":"Padang","year":"2014","journal-title":"Heart Lung Circ"},{"key":"R5-20260421","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.athoracsur.2015.09.050","article-title":"Diagnosing neonatal aortic coarctation in the setting of patent ductus arteriosus","volume":"101","author":"Peng","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"R6-20260421","doi-asserted-by":"crossref","first-page":"4","DOI":"10.3348\/kjr.2010.11.1.4","article-title":"State-of-the-art CT imaging techniques for congenital heart disease","volume":"11","author":"Goo","year":"2010","journal-title":"Korean J Radiol"},{"key":"R7-20260421","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/j.echo.2008.02.006","article-title":"Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: An echocardiographic study","volume":"21","author":"Pettersen","year":"2008","journal-title":"J Am Soc Echocardiogr"},{"key":"R9-20260421","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.echo.2020.09.019","article-title":"Pediatric heart network echocardiographic z scores: Comparison with other published models","volume":"34","author":"Lopez","year":"2021","journal-title":"J Am Soc Echocardiogr"},{"key":"R10-20260421","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/1532-429X-10-56","article-title":"Normal values for aortic diameters in children and adolescents \u2013 Assessment in vivo by contrast-enhanced CMR-angiography","volume":"10","author":"Kaiser","year":"2008","journal-title":"J Cardiovasc Magn Reson"},{"key":"R11-20260421","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1148\/radiol.14140500","article-title":"Determining the normal aorta size in children","volume":"274","author":"Hegde","year":"2015","journal-title":"Radiology"},{"key":"R12-20260421","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A guideline of selecting and reporting intraclass correlation coefficients for reliability research","volume":"15","author":"Koo","year":"2016","journal-title":"J Chiropr Med"},{"key":"R13-20260421","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1136\/hrt.64.2.133","article-title":"Continuous wave Doppler echocardiography and coarctation of the aorta: Gradients and flow patterns in the assessment of severity","volume":"64","author":"Carvalho","year":"1990","journal-title":"Br Heart J"},{"key":"R14-20260421","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1007\/s10554-018-1394-1","article-title":"Do CTA measurements of annular diameter, perimeter and area result in different TAVI prosthesis sizes?","volume":"34","author":"Horehledova","year":"2018","journal-title":"Int J Cardiovasc Imaging"},{"key":"R15-20260421","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1080\/03091902.2022.2026505","article-title":"In vitro four-dimensional flow magnetic resonance analysis of the effect of pericardial valve design on aortic flow","volume":"46","author":"Tasca","year":"2022","journal-title":"J Med Eng Technol"},{"key":"R16-20260421","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s43057-023-00114-w","article-title":"Assessment of anatomy of the aorta in patients with a coarctation of aorta","volume":"31","author":"Turaev","year":"2023","journal-title":"Cardiothorac Surg"},{"key":"R17-20260421","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.athoracsur.2023.11.027","article-title":"Regional arch measurements differ between imaging modalities in infants with aortic coarctation","volume":"118","author":"Iguidbashian","year":"2024","journal-title":"Ann Thorac Surg"},{"key":"R18-20260421","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1148\/rg.2020190164","article-title":"CAD-RADS: Pushing the limits","volume":"40","author":"Canan","year":"2020","journal-title":"Radiographics"}],"container-title":["Annals of Pediatric Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/apc.apc_221_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:39:13Z","timestamp":1786649953000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/apc.apc_221_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/apc.apc_221_24","relation":{},"ISSN":["0974-2069","0974-5149"],"issn-type":[{"value":"0974-2069","type":"print"},{"value":"0974-5149","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2024-11-15","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-30","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}