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Guillaumont S, Vincenti M, Thomas F, Huguet H, Picot MC, Abassi H, Huby AC, Laux D, Thomas-Chabaneix J, Cohen L, Gavotto A, Amedro P. Implications of right aortic arch prenatal diagnosis: the multicentric nationwide ARCADE cohort. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327242. [PMID: 38964845 DOI: 10.1136/archdischild-2024-327242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES This study aims to describe the various presentations of the prenatally diagnosed isolated right aortic arch (RAA), that is, without associated congenital heart defect and to evaluate the impact of prenatal diagnosis of isolated RAA in terms of postnatal outcome. METHOD In this multicentric retrospective study, from 2010 to 2019, all live births with a prenatal ultrasound diagnosis of isolated RAA were included, with a 1-year postnatal follow-up. The concordance between the different diagnostic steps (prenatal ultrasound, postnatal ultrasound and postnatal CT scan) was evaluated using Gwet's AC1 coefficient. RESULTS A total of 309 cases of prenatally diagnosed RAA were analysed, most of which had a left ductus arteriosus (83%). The concordance between prenatal and postnatal ultrasound diagnosis was excellent regarding the RAA type (AC1=0.97, 95% CI=(0.94 to 0.99)). The rare discrepancies mainly involved non-diagnosed or misdiagnosed double aortic arch (2%). CT scan was performed in 108 neonates (35%) and the concordance between prenatal ultrasound and postnatal CT scan was good regarding the RAA diagnosis (AC1=0.80, 95% CI=(0.69 to 0.90)) but poor regarding the distribution of brachiocephalic vessels (AC1=0.21, 95% CI=(0.06 to 0.36)). An associated genetic anomaly was sought for in half of the cases and identified in 4% of the cohort. During the first year of life, 50 (18%) infants presented with vascular ring symptoms and 24 (8%) underwent aortic arch surgery. CONCLUSION This multicentric nationwide cohort of 309 prenatally diagnosed isolated RAA demonstrated the reliability of prenatal screening, highlighted the rare cases of discrepancies between prenatal and postnatal diagnosis and underlined the value of CT scan to improve the postnatal follow-up. TRIAL REGISTRATION NUMBER NCT04029064.
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Affiliation(s)
- Sophie Guillaumont
- Foetal and Paediatric Cardiology Explorations Unit, Saint-Pierre Institute, Palavas-les-Flots, France
- Department of Paediatric and Congenital Cardiology, Montpellier University Hospital, Montpellier, France
| | - Marie Vincenti
- Department of Paediatric and Congenital Cardiology, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM U1046, University of Montpellier, Montpellier, France
| | - Fanny Thomas
- Department of Paediatric and Congenital Cardiology, Montpellier University Hospital, Montpellier, France
- Department of Paediatric and Congenital Cardiology, Tours University Hospital, Tours, France
| | - Helena Huguet
- Department of Epidemiology and Biostatistics, Montpellier University Hospital, Montpellier, France
| | - Marie-Christine Picot
- Department of Epidemiology and Biostatistics, Montpellier University Hospital, Montpellier, France
| | - Hamouda Abassi
- Department of Paediatric and Congenital Cardiology, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM U1046, University of Montpellier, Montpellier, France
| | - Anne-Cecile Huby
- Department of Paediatric and Congenital Cardiology, National Reference Centre for Complex Congenital Heart Disease, CRMR M3C, Bordeaux University Hospital, Bordeaux, France
- Aquitaine Congenital Anomalies Registry, ATENA, Bordeaux University Hospital, Bordeaux, France
| | - Daniela Laux
- Cardiology and Congenital Heart Disease Explorations Unit, UE3C Lowendal, Paris, France
| | - Julie Thomas-Chabaneix
- Department of Paediatric and Congenital Cardiology, National Reference Centre for Complex Congenital Heart Disease, CRMR M3C, Bordeaux University Hospital, Bordeaux, France
- Aquitaine Congenital Anomalies Registry, ATENA, Bordeaux University Hospital, Bordeaux, France
| | - Laurence Cohen
- Foetal, Paediatric and Adult Congenital Cardiology Explorations Unit, ETCC, Massy, France
| | - Arhur Gavotto
- Department of Paediatric and Congenital Cardiology, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM U1046, University of Montpellier, Montpellier, France
- Pediatric Intensive Care Unit, Montpellier University Hospital, Montpellier, France
| | - Pascal Amedro
- Department of Paediatric and Congenital Cardiology, National Reference Centre for Complex Congenital Heart Disease, CRMR M3C, Bordeaux University Hospital, Bordeaux, France
- IHU Liryc, INSERM U1045, University of Bordeaux, Bordeaux, France
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Tidrenczel Z, P Tardy E, Ladányi A, Hajdú J, Böjtös I, Sarkadi E, Simon J, Demeter J. [Prenatally detected aortic arch anomalies and their consequences after birth]. Orv Hetil 2023; 164:1111-1120. [PMID: 37454329 DOI: 10.1556/650.2023.32793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/25/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Aortic arch anomalies are frequently associated with cardiac or extracardiac malformations, chromosomal aberrations and postpartum esophagus/trachea compression. OBJECTIVE We aimed to establish the prevalence of associated cardiac and extracardiac malformations, the frequency of chromosomal aberrations in fetuses with the diagnosis of aortic arch anomalies and to assess the pregnancy and the postnatal outcome. METHOD Retrospective cohort study of all fetuses with aortic arch anomalies and genetic diagnosis in a tertiary referral obstetric and fetal cardiology centre between 2016 and 2020. Postpartum data were collected within 24 months after birth. RESULTS In a cohort of 11.380 pregnant women, the prevalence of aortic arch anomalies was 0.25%. Among 28 cases of right aortic arch anomalies, in 27 fetuses prenatal genetic diagnosis was available. We diagnosed 4 fetuses with mirror-image branching (right sided V-sign) and 23 fetuses with U-sign (4 fetuses with complete double aortic arch). 18 cases (66%) were isolated. Associated anomalies were cardiac in 3 cases and extracardiac in 7 cases (33%). The most frequent cardiac anomaly was tetralogy of Fallot (2/27), the extracardiac anomalies were thymus hypoplasia, single umbilical artery and subclavian artery malformations. In 1 case (3.7%), fluorescent in situ hybridization diagnosed 22q11.2 microdeletion. 75% of fetuses with right sided V-sign were associated with conotruncal malformations. Pregnancy and postpartum outcome were known in 24 pregnancies. Postnatal diagnosis was different from prenatal in 2 cases, the concordance rate was 93%. Isolated cases resulted in live birth in 17/18 pregnancies (93%). The frequency of postpartum trachea/esophagus compression was 42,9% (9 cases) due to vascular ring, in 6 children (28,6%) operation was necessary. CONCLUSION Fetal aortic arch anomalies are multidisciplinary diseases to be diagnosed by proper prenatal ultrasound examination. Associated fetal anomalies necessitate extended obstetric and cardiac sonography, invasive prenatal testing should be offered, and thorough postnatal long-term follow-up is recommended. Orv Hetil. 2023; 164(28): 1111-1120.
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Affiliation(s)
- Zsolt Tidrenczel
- 1 Észak-pesti Centrumkórház - Honvédkórház, Szülészet-Nőgyógyászati Osztály, Genetikai Centrum Budapest, Podmaniczky u. 111., 1062 Magyarország
| | - Erika P Tardy
- 2 Észak-pesti Centrumkórház - Honvédkórház, Központi Laboratóriumi Diagnosztikai Osztály Budapest Magyarország
| | - Anikó Ladányi
- 3 Gottsegen György Országos Kardiovaszkuláris Intézet, Magzati Kardiológiai Munkacsoport Budapest Magyarország
| | - Júlia Hajdú
- 3 Gottsegen György Országos Kardiovaszkuláris Intézet, Magzati Kardiológiai Munkacsoport Budapest Magyarország
| | - Ildikó Böjtös
- 2 Észak-pesti Centrumkórház - Honvédkórház, Központi Laboratóriumi Diagnosztikai Osztály Budapest Magyarország
| | - Edina Sarkadi
- 2 Észak-pesti Centrumkórház - Honvédkórház, Központi Laboratóriumi Diagnosztikai Osztály Budapest Magyarország
| | - Judit Simon
- 2 Észak-pesti Centrumkórház - Honvédkórház, Központi Laboratóriumi Diagnosztikai Osztály Budapest Magyarország
| | - János Demeter
- 1 Észak-pesti Centrumkórház - Honvédkórház, Szülészet-Nőgyógyászati Osztály, Genetikai Centrum Budapest, Podmaniczky u. 111., 1062 Magyarország
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Prenatal Diagnosis of the Right Aortic Arch: Change in Detection Rate, the Status of Associated Anomalies, and Perinatal Outcomes in 137 Fetuses. Pediatr Cardiol 2022; 43:1888-1897. [PMID: 35568727 DOI: 10.1007/s00246-022-02929-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
To evaluate prenatal findings of the right aortic arch (RAA), associated cardiac, extracardiac, and genetic anomalies, its perinatal outcomes and the need for postnatal interventions in cases of isolated RAA with a view to facilitating appropriate counseling. This was a multicenter, cohort study, that was undertaken in two international major cardiac centers between 2009 and 2020. The study subjects were prenatally diagnosed RAA cases with and without other structural cardiac defects. A RAA was identified in 137 fetuses. There were 84 cases of isolated RAA. Associations with additional intracardiac malformations were found in 53 (38.7%) cases. An extracardiac anomaly was observed in 26/137 (18.9%) fetuses, 11/84 (13.0%) fetuses with isolated RAA, and 15/53 (28.3%) fetuses with an additional intracardiac anomaly. The incidence of extracardiac and chromosomal anomalies was significantly higher in cases of RAA with abnormal intracardiac anatomy (28.3-18.8%, respectively), compared with RAA with normal intracardiac anatomy (13.0-5.9%, respectively) (p < 0.05). 22q11.2 microdeletion was found higher in RAA with CHD (4/18 fetuses) than isolated RAA (2/24 fetuses) (22.2% vs. 8.3% respectively). ALSA was present in 19.3% of cases. ALSA was more frequently observed in cases of isolated RAA (23.6%), than in RAA with structural CHD (7.6%) (p < 0.05). The pregnancy was interrupted in six fetuses, and one died in utero. The mortality rate was higher in fetuses with intracardiac anomaly than RAA without cardiac anomaly (11/49 (22.4%) vs. 2/81 (2.4%). Vascular ring formation was revealed in 21/98 cases. The RAA caused symptoms of a vascular ring in only one patient (0.7%) requiring surgery in the follow-up. Overall survival after initial diagnosis in the total cohort was 85.4% with 38 of 53 (71%) RAA with CHD cases and 79 of 84 (94.0%) isolated RAA cases. Chromosomal and extracardiac anomalies are lower in isolated RAA but not negligible hence amniocentesis should be routinely offered in all cases. The requirement for postnatal intervention in the immediate neonatal period is remote, therefore delivery of these fetuses need not be undertaken at a cardiac or surgical center.
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Petrescu AM, Ruican D, Pătru CL, Zorilă GL, Tudorache Ş, Comănescu AC, Istrate-Ofiţeru AM, Badiu AM, Ioana M, Stoica GA, Iliescu DG. Prenatal findings and pregnancy outcome in fetuses with right and double aortic arch. A 10-year experience at a tertiary center. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2020; 61:1173-1184. [PMID: 34171066 PMCID: PMC8343474 DOI: 10.47162/rjme.61.4.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/27/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Our objective was to evaluate the accuracy of the prenatal diagnosis and the relation between the type of right aortic arch (RAA) with other intra- or extracardiac (EC) and chromosomal anomalies. METHODS A retrospective, observational study was conducted between 2011-2020 in a Romanian tertiary center. All RAA cases, including double aortic arch (DAA), were extracted from the databases and studied thoroughly. RESULTS We detected 18 RAA cases: five (27.78%) type I (mirror image, "V" type), 11 (61.12%) type II ("U" type), and two (11.10%) DAA cases. Heart anomalies were associated in 38.89% (overall), 60% (type I), 36.37% (type II), and 0% (DAA) cases. Tetralogy of Fallot represented the most prevalent cardiac malformation (in 22.23% of cases). EC anomalies were present in 44.44% of fetuses (20% of type I, 54.55% of type II, and 50% of DAA cases). Genetic abnormalities were found in 41.17% of pregnancies, with 22q11.2 deletion in 23.53%. 55.55% of the cases had a good neonatal evolution and 44.45% of the pregnancies were terminated. An overall good outcome of pregnancy was noted in 40% of type I RAA, 63.64% of type II RAA, and 50% of DAA cases. All RAA cases examined in the first trimester were correctly diagnosed. CONCLUSIONS RAA can be accurately diagnosed and classified by means of prenatal ultrasound since early pregnancy. A detailed anatomy scan and genetic testing, including 22q11 deletion, should be offered to all pregnancies when RAA is discovered. When isolated, RAA associates a good outcome, indifferently the anatomical type.
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Affiliation(s)
- Ana-Maria Petrescu
- Department of Obstetrics and Gynecology, Emergency County Hospital, Craiova, Romania
| | - Dan Ruican
- Department of Obstetrics and Gynecology, Emergency County Hospital, Craiova, Romania
| | - Ciprian Laurenţiu Pătru
- Department of Obstetrics and Gynecology, Emergency County Hospital, Craiova, Romania
- Department of Mother and Child, University of Medicine and Pharmacy of Craiova, Romania
| | - George Lucian Zorilă
- Department of Obstetrics and Gynecology, Emergency County Hospital, Craiova, Romania
- Department of Mother and Child, University of Medicine and Pharmacy of Craiova, Romania
| | - Ştefania Tudorache
- Department of Obstetrics and Gynecology, Emergency County Hospital, Craiova, Romania
- Department of Mother and Child, University of Medicine and Pharmacy of Craiova, Romania
| | - Alexandru Cristian Comănescu
- Department of Obstetrics and Gynecology, Emergency County Hospital, Craiova, Romania
- Department of Mother and Child, University of Medicine and Pharmacy of Craiova, Romania
| | - Anca-Maria Istrate-Ofiţeru
- Department of Obstetrics and Gynecology, Emergency County Hospital, Craiova, Romania
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
- Research Center for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, Romania
| | - Anne Marie Badiu
- Department of Pathology, Emergency County Hospital, Craiova, Romania
| | - Mihai Ioana
- Department of Medical Genetics, University of Medicine and Pharmacy of Craiova, Romania
| | - George Alin Stoica
- Department of Pediatric Surgery, Emergency County Hospital, Craiova, Romania
| | - Dominic Gabriel Iliescu
- Department of Obstetrics and Gynecology, Emergency County Hospital, Craiova, Romania
- Department of Mother and Child, University of Medicine and Pharmacy of Craiova, Romania
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