دورية أكاديمية
أعرض في EDS

Double aortic arch: implications of antenatal diagnosis, differential growth of arches during pregnancy, associated abnormalities and postnatal outcome.

التفاصيل البيبلوغرافية
العنوان: Double aortic arch: implications of antenatal diagnosis, differential growth of arches during pregnancy, associated abnormalities and postnatal outcome.
المؤلفون: Bartsota M; Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, London, UK., Jowett V; Great Ormond Street Hospital, London, UK., Manuel D; Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, London, UK., Mortensen K; Great Ormond Street Hospital, London, UK., Wolfenden J; Great Ormond Street Hospital, London, UK., Marek J; Great Ormond Street Hospital, London, UK.; Institute of Cardiovascular Sciences, University College London, London, UK., Carvalho JS; Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, London, UK.; Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.; Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
المصدر: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology [Ultrasound Obstet Gynecol] 2023 Jul; Vol. 62 (1), pp. 69-74. Date of Electronic Publication: 2023 Jun 09.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: John Wiley & Sons, Ltd Country of Publication: England NLM ID: 9108340 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1469-0705 (Electronic) Linking ISSN: 09607692 NLM ISO Abbreviation: Ultrasound Obstet Gynecol Subsets: MEDLINE
أسماء مطبوعة: Publication: 2003- : Chichester, West Sussex, UK : John Wiley & Sons, Ltd.
Original Publication: Carnforth, Lancs, UK ; Park Ridge, N.J., USA : Parthenon Pub., c1991-
مواضيع طبية MeSH: Aortic Arch Syndromes*/diagnostic imaging , Aortic Arch Syndromes*/genetics , Vascular Ring*/diagnostic imaging , Vascular Ring*/genetics, Female ; Humans ; Pregnancy ; Aorta, Thoracic/diagnostic imaging ; Chromosome Aberrations ; Diagnosis, Differential ; Parturition ; Pregnancy Outcome ; Prenatal Diagnosis/methods ; Retrospective Studies ; Ultrasonography, Prenatal/methods
مستخلص: Objectives: To evaluate the prenatal characteristics of double aortic arch (DAA), assess the relative size of the arches and their growth during pregnancy, describe associated cardiac, extracardiac and chromosomal/genetic abnormalities and review postnatal presentation and clinical outcome.
Methods: This was a retrospective cohort study of all fetuses with a confirmed diagnosis of DAA seen in five specialized referral centers in London, UK, between October 2012 and November 2019. Cases were identified from the hospitals' fetal databases. Fetal echocardiographic findings, intracardiac and extracardiac abnormalities, genetic defects, computed tomography (CT) findings and postnatal clinical presentation and outcome were evaluated.
Results: A total of 79 fetuses with DAA were included. Of those assessed postnatally, 48.6% had an atretic left aortic arch (LAA), while 5.1% had an atretic LAA at the first fetal scan and were misdiagnosed antenatally with right aortic arch (RAA). The LAA was atretic in 55.8% of those who underwent CT. DAA was an isolated abnormality in 91.1% of cases; 8.9% of patients had an additional intracardiac abnormality and 2.5% had both intra- and extracardiac abnormalities. Among the 52 cases that underwent genetic testing, 11.5% had genetic abnormalities and, specifically, the 22q11 microdeletion was identified in 3.8% of patients. At a median follow-up of 993.5 days, 42.5% of patients had developed symptoms of tracheoesophageal compression (5.5% during the first month after birth) and 56.2% had undergone intervention. Statistical analysis using the χ-square test showed no significant relationship between morphology of DAA (patency of both aortic arches vs atretic LAA) and the need for intervention (P = 0.134), development of vascular ring symptoms (P = 0.350) or evidence of airway compression on CT (P = 0.193).
Conclusions: Most cases of DAA can be diagnosed easily at midgestation, as typically both arches are patent with a dominant RAA at this stage. However, we found that the LAA had become atretic in approximately half of the cases postnatally, supporting the theory of differential growth of the arches during pregnancy. DAA is usually an isolated abnormality; however, thorough assessment is required to exclude associated intra- and extracardiac anomalies and to determine the need for invasive prenatal genetic testing. Postnatally, early clinical assessment is needed and CT scan should be considered, irrespective of the presence of symptoms. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
(© 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.)
References: Achiron R, Rotstein Z, Heggesh J, Bronshtein M, Zimand S, Lipitz S, Yagel S. Anomalies of the fetal aortic arch: a novel sonographic approach to in-utero diagnosis. Ultrasound Obstet Gynecol 2002; 20: 553-557.
Mogra R, Kesby G, Sholler G, Hyett J. Identification and management of fetal isolated right-sided aortic arch in an unselected population. Ultrasound Obstet Gynecol 2016; 48: 739-743.
Guo Q, Kong Y, Zeng S, Zhou J, Wang X, Shang Q, Zhou J, Yuan H, Wang L, Tong L, Yi A, Zhou Q. Fetal double aortic arch: prenatal sonographic and postnatal computed tomography angiography features, associated abnormalities and clinical outcomes. BMC Pregnancy Childbirth 2020; 20: 614.
Moes CAF. Vascular rings and related conditions. In Congenital Heart Disease: Textbook of Angiocardiography, Freedom RM, Mawson JB, Yoo S-J, Benson LN (eds). Futura Publishing Co: Armonk, NY, USA, 1997; 947-983.
Edwards JE. Vascular rings and slings. In Fetal, Neonatal, and Infant Cardiac Disease, Moller JH, Neal WA (eds). Appleton & Lange: Norwalk, CT, USA, 1990; 745-754.
UK Government. 20-week screening scan. https://www.gov.uk/government/publications/fetal-anomaly-screening-programme-handbook/20-week-screening-scan.
Carvalho JS, Ho SY, Shinebourne EA. Sequential segmental analysis in complex fetal cardiac abnormalities: a logical approach to diagnosis. Ultrasound Obstet Gynecol 2005; 26: 105-111.
Priya S, Nagpal P. Atretic double aortic arch: imaging appearance of a rare anomaly and differentiation from its mimics. Cureus 2020; 12: e9478.
Vigneswaran TV, Van Poppel MPM, Griffiths B, James P, Jogeesvaran H, Rahim Z, Simpson JM, Speggiorin S, Zidere V, Nyman A. Postnatal impact of a prenatally diagnosed double aortic arch. Arch Dis Child 2021; 106: 564-569.
McElhinney DB, Clark BJ 3rd, Weinberg PM, Kenton ML, McDonald-McGinn D, Driscoll DA, Zackai EH, Goldmuntz E. Association of chromosome 22q11 deletion with isolated anomalies of aortic arch laterality and branching. J Am Coll Cardiol 2001; 37: 2114-2119.
D'Antonio F, Khalil A, Zidere V, Carvalho JS. Fetuses with right aortic arch: a multicenter cohort study and meta-analysis. Ultrasound Obstet Gynecol 2016; 47: 423-432.
Berg C, Bender F, Soukup M, Geipel A, Axt-Fliedner R, Breuer J, Herberg U, Gembruch U. Right aortic arch detected in fetal life. Ultrasound Obstet Gynecol 2006; 28: 882-889.
Miranda JO, Callaghan N, Miller O, Simpson J, Sharland G. Right aortic arch diagnosed antenatally: associations and outcome in 98 fetuses. Heart 2014; 100: 54-59.
Trobo D, Bravo C, Alvarez T, Perez R, Gamez F, De Leon-Luis J. Prenatal sonographic features of a double aortic arch: literature review and perinatal management. J Ultrasound Med 2015; 34: 1921-1927.
Yerlikaya G, Efeturk T, Springer S, Reischer T. Prenatal detection of right aortic arch. Arch Gynecol Obstet 2019; 299: 933-938.
فهرسة مساهمة: Keywords: double aortic arch; echocardiography; postnatal outcome; prenatal diagnosis; vascular ring
تواريخ الأحداث: Date Created: 20230302 Date Completed: 20230731 Latest Revision: 20240405
رمز التحديث: 20240405
DOI: 10.1002/uog.26186
PMID: 36864493
قاعدة البيانات: MEDLINE
الوصف
تدمد:1469-0705
DOI:10.1002/uog.26186