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Vigneswaran TV, Hunter LE, Carvalho JS, Seale AN. Management of prenatally detected vascular rings: a United Kingdom national survey. Cardiol Young 2023; 33:1332-1335. [PMID: 35968842 DOI: 10.1017/s1047951122002268] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate UK variability in prenatal and postnatal management strategy of right aortic arch and double aortic arch (RAA/DAA). METHODS Online surveys were sent to senior physicians (consultants) of the National Fetal Cardiology Working Group regarding prenatal diagnosis, counselling, and perinatal management of antenatally diagnosed RAA/DAA and to the British Congenital Cardiovascular Association regarding postnatal management strategies. RESULTS There were 28 prenatal and 90 postnatal surveys completed. Prenatally, there was consensus for potential associated chromosomal/genetic anomalies, but there was variation in the risk quoted. Confidence in defining aortic arch morphology was reported by 43% (12/28) of fetal cardiologists. There was variation in what was felt to be possible symptoms/signs of a compressive vascular ring, postnatal investigation, postnatal management, follow-up duration of asymptomatic patients, and indications for surgical intervention. CONCLUSION This study has highlighted important areas for future research: improving accuracy of prenatal diagnosis, clarification of potential symptoms, optimal investigation strategies, and indications for surgery.
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Affiliation(s)
- Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Trust, LondonSE1 7EH, UK
| | - Lindsey E Hunter
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | - Julene S Carvalho
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, 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
| | - Anna N Seale
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Heart Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
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Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Berthoty D, Montes A, Mayman GA, Restrepo H. Isolated Vascular Rings Are Common Cardiovascular Malformations. World J Pediatr Congenit Heart Surg 2023; 14:21-23. [PMID: 36847763 DOI: 10.1177/21501351221122972] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE We investigated the prevalence of isolated vascular rings in the general population of Southern Nevada. METHODS We identified those prenatally and postnatally diagnosed with an isolated vascular ring between January 2014 and December 2021. We included only those with vascular or ligamentous structures completely encircling the trachea and esophagus. To investigate the prevalence of isolated vascular rings, we included only those with situs solitus, levocardia, and no significant intracardiac malformations. RESULTS We identified 112 patients. Of the 112, 66 (59%) were female. There were approximately 211,000 total live births in Southern Nevada for the study period, for an overall prevalence of 5.3 isolated vascular rings per 10 000 live births. However, for the years 2014 to 2017, the average prevalence figure was 3.5 per 10 000 live births, and for the years 2018 to 2021, the average prevalence figure was 7.1 (range 6.5-8.0) per 10 000 live births. Simultaneously, the prenatal detection rate rose from 66% to 86%. CONCLUSIONS Isolated vascular rings are common cardiovascular malformations. As prenatal detection rates in the Southern Nevada general population approach 90%, the prevalence figures for isolated vascular rings appear to asymptote at about 7 per 10 000 live births.
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Affiliation(s)
- William N Evans
- Congenital Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ruben J Acherman
- Congenital Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Michael L Ciccolo
- Congenital Heart Center Nevada, Las Vegas, NV, USA.,Department of Surgery, Kirk Kerkorian School of Medicine at the 14722University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Juan Lehoux
- Congenital Heart Center Nevada, Las Vegas, NV, USA
| | - Dean Berthoty
- 497616Sunrise Children's Hospital, Department of Radiology, Las Vegas, NV, USA
| | - Arthur Montes
- 497616Sunrise Children's Hospital, Department of Radiology, Las Vegas, NV, USA
| | - Gary A Mayman
- Congenital Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Humberto Restrepo
- Congenital Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, NV, USA
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Swarnkar P, Speggiorin S, Austin BC, Nyman A, Salih C, Zidere V, Simpson JM, Vigneswaran TV. Contemporary surgical outcome and symptomatic relief following vascular ring surgery in children: effect of prenatal diagnosis. Eur J Cardiothorac Surg 2022; 61:1260-1268. [PMID: 35022705 DOI: 10.1093/ejcts/ezab527] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/05/2021] [Accepted: 10/24/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Our goal was to describe postoperative complications and outcomes in a large contemporary cohort of children with an isolated double aortic arch (DAA) or a right aortic arch (RAA) with left arterial ligament and to assess the impact of foetal diagnosis on outcomes. METHODS We performed a retrospective analysis of all patients who underwent surgery for DAA or RAA with left arterial ligament between 2005 and 2019. RESULTS A total of 132 children were operated on for a DAA (n = 77) or a RAA (n = 55). Prenatal diagnosis was made in 100/132 (75.8%). Median age at surgery for DAA was 5.0 (1.7-13.3) months and for RAA was 13.9 (6.4-20.1) months. There was no difference in the age at surgery between the prenatal and postnatal cases (8.6 [4.0-15.6] vs 5.4 months [1.8-17.7]; P = 0.37). No surgical deaths occurred. Vocal cord palsy was the most common complication, occurring in 12/132 (9%): of these, 11 resolved spontaneously and 1 required a temporary tracheostomy. Logistic regression demonstrated that older age at operation was the only predictor for a postoperative complication (P = 0.02). Overall, 21/67 (31%) of prenatally detected, symptomatic cases reported residual symptoms/signs 1 year after surgery compared to 18/28 (64%) of postnatally detected cases. Postnatal diagnosis was associated with persistent postoperative symptoms/signs [P = 0.006, odds ratio = 3.9 (95% confidence interval 1.5-9.4)]. CONCLUSIONS Surgery to relieve a vascular ring resolves trache-oesophageal compressive symptoms in most cases, but parents/patients should be aware that symptoms/signs may persist in the first postoperative year despite effective release of the vascular ring. Earlier surgery and prenatal diagnosis may improve outcomes.
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Affiliation(s)
- Parinita Swarnkar
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Guy's, King's & St Thomas' School of Medicine, King's College London, London, UK
| | - Simone Speggiorin
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - B Conal Austin
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Andrew Nyman
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Caner Salih
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
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Vigneswaran TV, Jabak S, Syngelaki A, Charakida M, Simpson JM, Nicolaides KH, Zidere V. Prenatal incidence of isolated right aortic arch and double aortic arch. J Matern Fetal Neonatal Med 2021; 34:2985-2990. [PMID: 31578117 DOI: 10.1080/14767058.2019.1676413] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To define the incidence of variants of aortic arch sidedness in fetuses undergoing routine first trimester ultrasound examination. METHODS The data for this study were derived from prospective routine ultrasound examination at 11+0 to 13+6 weeks' gestation in singleton pregnancies examined in a local population between January 2014 and March 2018. We examined the incidence of isolated right aortic arch (RAA) and double aortic arch (DAA) in the local, screened population and compared the groups with and without these abnormalities. RESULTS The study population of 33,202 pregnancies included 18 (5.4 per 10,000) cases with isolated RAA and 5 (1.5 per 10,000) with DAA. In the group with isolated RAA or DAA, compared to those without, the median maternal age was higher and the incidence of conceptions from in vitro fertilization (IVF) was eight-fold higher. The prevalence of 22q11microdeletion was 5% in patients with RAA from this local population. CONCLUSIONS The incidence of isolated RAA and DAA in a local population undergoing routine first-trimester ultrasound examination is 2-3-fold higher than that reported in postnatal studies and the risk for these abnormalities is substantially increased in fetuses conceived by IVF.
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Affiliation(s)
- Trisha V Vigneswaran
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Salma Jabak
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Argyro Syngelaki
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Marietta Charakida
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - John M Simpson
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Kypros H Nicolaides
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Vita Zidere
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
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Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Berthoty D, Mayman GA, Restrepo H. Isolated vascular rings in the era of high prenatal detection rates: Demographics, diagnosis, risk factors, and outcome. J Card Surg 2021; 36:1381-1388. [PMID: 33586208 DOI: 10.1111/jocs.15414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We reviewed our center's isolated vascular ring data. METHODS Inclusion criteria were patients born in Nevada between June 2015 and July 2020 with situs solitus, levocardia, atrioventricular and ventriculoarterial concordance, and no significant intracardiac malformations. RESULTS We identified 95 patients. Of the 95, 56 (59%) were female (p = .033). For the study period, there were approximately 180,000 live births, for a prevalence of 5.3 isolated vascular rings per 10,000 live births. Of the 95, 78 (82%) were prenatally diagnosed. Of the 95, 63 (66%) were products of high-risk pregnancies (p = .0001). Additionally, we found advanced maternal age was an isolated vascular ring risk factor (relative risk ratio, 2.7; 95% confidence interval, 1.8, 4.1; p < .00001). CONCLUSIONS Isolated vascular rings are relatively common cardiovascular malformations and more common in females. High prenatal detection rates are achievable. Further, the majority with isolated vascular rings are products of high-risk pregnancies, and advanced maternal age is a statistically significant occurrence risk factor.
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Affiliation(s)
- William N Evans
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, School of Medicine, Division of Pediatric Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ruben J Acherman
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, School of Medicine, Division of Pediatric Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Michael L Ciccolo
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Surgery, School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Juan Lehoux
- Children's Heart Center Nevada, Las Vegas, Nevada, USA
| | - Dean Berthoty
- Department of Radiology, Sunrise Children's Hospital, Las Vegas, Nevada, USA
| | - Gary A Mayman
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, School of Medicine, Division of Pediatric Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Humberto Restrepo
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, School of Medicine, Division of Pediatric Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
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