Congenital Arch Anomalies Research Articles

Clues and techniques of prenatal ultrasonographic diagnosis for fetal aortic arch anomalies

Objective To explore the ultrasonographic features, diagnostic clues and methods of fetal aortic arch anomalies, and to improve the diagnosis rate of prenatal ultrasonography for fetal aortic arch anomalies. Methods Fetuses with aortic arch anomalies diagnosed by prenatal ultrasound were selected as the study objects. The prenatal ultrasonographic features of the three views of the aortic arch were carefully observed. The three views included the followings: the transverse view(the view of three vessels and trachea), the sagittal view (the longitudinal view of the aortic arch), and the coronal view (the coronal view of the descending aorta). The prenatal diagnostic clues and diagnostic techniques of aortic arch anomalies were summarized and analyzed. Results Eighty-one cases with aortic arch anomalies were followed up. Fifteen cases were left-sided aortic arch and left-sided ductus arteriosus with aberrant right subclavian artery, 22 cases with right aortic arch and left-sided ductus arteriosus with aberrant left subclavian artery, 4 cases were mirror right aortic arch and left-sided ductus arteriosus, 2 cases were mirror right aortic arch and right-sided ductus arteriosus, 11 cases were double aortic arch, 23 cases were coarctation of the aorta, and 4 cases were interruption of aortic arch. Among them, 27 cases were complicated with other cardiac and extra-cardiac malformations and 13 cases with chromosomal abnormalities. Prenatal ultrasonographic clues for diagnosis of coarctation of the aorta included the three vessels and trachea view showing small diameter and disproportion to the diameter of the ductus arteriosus. And the longitudinal view of the aortic arch was helpful for showing the position and the extent of coarctation of the aorta. Prenatal ultrasonographic clues for diagnosis of interruption of aortic arch were that the three vessels and trachea view and the longitudinal view of the aortic arch showed the interruption between aortic arch and descending aorta. And the abnormal combination cases of the aortic arch segments also had their corresponding diagnostic clues. These clues included that the three vessels and trachea view showed abnormal position, arrangement and running of the branches of the aortic arch. And the coronal view of the descending aorta also showed abnormal changes in the branches of aortic arch. Conclusions Various types of congenital aortic arch anomalies have characteristic ultrasonography and their corresponding diagnostic clues and methods. The combined use of the three views of the aortic arch is effective in prenatal diagnosis for aortic arch anomalies. Key words: Ultrasonography, prenatal; Aortic arch anomalies; Diagnostic clues

An Interesting Case of Recurrent Chest Pain

Congenital arch anomalies are rarely described in adult literature, due to their subclinical course, as opposed to paediatric patients who tend to become symptomatic in the first few months of life. Double aortic arch (DAA), also known as a vascular ring, roughly accounts for 1–2% of congenital heart anomalies, although the real prevalence is unknown in the adult population.

In DeBakey Type I Aortic Dissection, Bovine Aortic Arch Is Associated With Arch Tears and Stroke

The study sought to evaluate if a bovine aortic arch (BAA) influences the location of the entry site in acute aortic dissection type A (AADA) and to identify the impact of BAA on postoperative outcome, especially stroke. A total of 315 patients underwent surgery due to AADA DeBakey type I (72.1% men, mean age 59.5 ± 13.4 years) between 2002 and 2015. Imaging studies and operative reports were screened for presence of BAA and location of the entry site. Patients were divided into 2 groups based on presence (BAA+) and absence (BAA-) of BAA (BAA+ n= 49, BAA- n= 264). Dissection patterns, surgical treatment, risk factors for postoperative complications, and long-term outcome were analyzed. Prevalence of BAA in patients with AADA was 15.6%. Location of the entry site was more commonly in the aortic arch in patients with BAA (BAA+ 46.8% versus BAA- 14.3%; p < 0.001). Multivariable analysis identified BAA (odds ratio [OR], 5.9; 95% confidence interval [CI], 2.89 to 12.04; p < 0.001) and preoperative competent aortic valve (OR, 2.26; 95% CI, 1.19 to 4.31; p= 0.013) as independent predictors for an arch tear. Thirty-nine patients (12.4%) suffered from stroke. Patients with BAA had higher stroke rates (BAA+ 24.5% versus BAA- 10.2%; p= 0.009). BAA emerged as one risk factor for stroke in the setting of AADA (OR, 2.69; 95% CI, 1.2 to 6.0; p= 0.016). Long-term survival was comparable for patients with BAA and patients without congenital arch anomalies. BAA is an independent predictor for the distinctive location of the entry site in the aortic arch and risk factor for stroke.

Vascular anomalies causing tracheoesophageal compression: a 20-year experience in diagnosis and management.

Vascular rings and other congenital aortic arch anomalies may be major causes of tracheoesophageal obstruction in children. In this report, our diagnostic approach, surgical treatment, and early and late results for 30 patients are reported. During a 20-year period (1982-2002), 30 children underwent surgery for tracheoesophageal compression caused by aortic arch anomalies. The median age at operation was 8 months (range, 36 days to 94 months), and the median patient weight was 8 kg (range, 2.4-16 kg). At 53.3% of cases, double aortic arch was by far the most common encountered cause of compression. Patients were admitted with respiratory distress, stridor, apnea, dysphagia, or recurrent respiratory tract infections. Diagnosis was established by barium esophagogram, computed tomography, magnetic resonance imaging, and angiography. The operative approaches were through a left thoracotomy or a median sternotomy. Operative mortality rate was 3.3%. Follow-up data from 2 months to 10 years (mean follow-up, 34 weeks) were available for all 30 patients. Twenty-six patients (86.7%) were essentially free of symptoms, 3 patients (10%) had residual respiratory problems, and 1 patient (3.3 %) had a gastroesophageal reflux problem. These results suggest that surgical correction of symptomatic vascular rings can be performed with low mortality and morbidity rates.