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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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Long term respiratory morbidity in patients with vascular rings: a review. Ital J Pediatr 2023; 49:24. [PMID: 36797770 PMCID: PMC9936697 DOI: 10.1186/s13052-023-01430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/12/2023] [Indexed: 02/18/2023] Open
Abstract
Abnormalities in position and/or branching of the aortic arch can lead to vascular rings that may cause narrowing of the tracheal lumen due to external compression, or constriction of the oesophagus, causing symptoms that vary in relation to the anatomical vascular pattern and the relationship between these structures. Respiratory morbidity related to external airways compression is a major concern in children affected by vascular rings. Clinical presentation depends on the severity of the tracheal lumen reduction and the presence of associated tracheomalacia. Recurrent respiratory infections, wheezing, atelectasis, and hyperinflation are mostly reported. As they are nonspecific and therefore difficult to recognize, attention should be given to all children with history of respiratory distress, extubation failure, noisy breathing, and recurrent respiratory infections. Early diagnosis and referral to specialized centres can prevent the long-term complications and improve the respiratory outcomes of these patients.
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Role of aortopexy in the treatment of aberrant innominate artery in children. Pediatr Surg Int 2022; 39:47. [PMID: 36502450 DOI: 10.1007/s00383-022-05280-2] [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] [Accepted: 10/16/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to assess the surgical and follow-up outcomes in children who operated for aberrant innominate artery. METHODS A total of 15 consecutive patients (12 males, 3 females; mean age 16.3 ± 19.0 months; range 3 months to 6 years) who underwent aortopexy between February 2018 and December 2021 were evaluated. Demographic data, preoperative and postoperative clinical status and postoperative outcomes were retrospectively analyzed. RESULTS The mean age at operation was 16.3 ± 19.0 months. The median weight was 8.3 kg (range, 7-14.5 kg).There was no complications at intraoperative period. The mean percent degree of tracheal stenosis was 0.68 ± 0.12. The median (range) MV duration, PICU stay, and ward stay of the patients were 2 h (0-3 h), 2.5 days (1-4 days), and 5 days (3-8 days), respectively. The mean patients' number of emergency service applications and hospitalization at the preoperative period was 6.2 ± 3.9/2.3 ± 1.6 and, at the postoperative period was 3.3 ± 2.2/0.9 ± 0.8. In comparison of the preoperative and postoperative service application number and hospitalization number, there was significant difference (p < 0.005 and 0.006, respectively). No reoperation was required. There was no mortality. CONCLUSION Aberrant innominate artery is rarely seen. These pathologies misdiagnosis with different reactive airways. Following the diagnosis, treatment can be achieved by surgery successfully.
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Nada A, Cousins JP, Ahsan H, Kunin JR. Right aortic arch with mirror image branching pattern and isolated left brachiocephalic artery: A case report. Radiol Case Rep 2020; 15:1786-1791. [PMID: 32793318 PMCID: PMC7413991 DOI: 10.1016/j.radcr.2020.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/11/2020] [Accepted: 07/11/2020] [Indexed: 02/05/2023] Open
Abstract
We present a very rare case of right aortic arch with an isolated left brachiocephalic artery in a 35-year-old female. This entity is an extremely uncommon aortic arch anomaly which has associated multisystem symptoms. We briefly discuss the hypothetical double aortic arch model originally described by Edwards. The aortic embryology can explain the anatomic findings and imaging manifestations of the isolated left brachiocephalic artery. Multimodality imaging evaluation can be helpful in detection and categorization of aortic arch abnormalities. A diagnostic imaging approach should focus on elucidating the abnormal aortic arch and great vessels arrangement with determination of associated cardiac, vascular or visceral congenital abnormalities.
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Affiliation(s)
- Ayman Nada
- Department of Radiology, University of Missouri, One Hospital Dr. Columbia, MO, 65212, USA
| | - Joseph P Cousins
- Department of Radiology, University of Missouri, One Hospital Dr. Columbia, MO, 65212, USA
| | - Humera Ahsan
- Department of Radiology, University of Missouri, One Hospital Dr. Columbia, MO, 65212, USA
| | - Jeffrey R Kunin
- Department of Radiology, University of Missouri, One Hospital Dr. Columbia, MO, 65212, USA
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