Jan Sheng-Ling, Lin Ming-Chih, Chan Sheng-Ching
1Division of Pediatric Cardiology,Children's Medical Center,Taichung Veterans General Hospital,Taichung,Taiwan.
4Department of Nursing,Ta-Jen University,Pingtung County,Taiwan.
Cardiol Young. 2018 Aug;28(8):1024-1030. doi: 10.1017/S1047951118000872. Epub 2018 Jun 28.
Aberrant right subclavian artery is the most common congenital aortic arch anomaly. There are a few reports concerning the clinical manifestations and follow-up of this CHD detected by echocardiographic screening.
A total of 1737 full-term neonates, with a male-to-female ratio of 900:837, received echocardiographic screening. Neonates with or without isolated aberrant right subclavian artery were studied during infancy.
Among the 1737 cases, a total of 15 (0.86%) female-predominant neonates, with a male-to-female ratio of 6:9, had isolated aberrant right subclavian artery. They were compared with 20 age- and gender-matched normal neonates. There were no significant differences in maternal age, gestational age, or para gravity between the two groups, except for birth size (birth length- and weight-for-age percentiles, p = 0.006 and 0.045, respectively), which was smaller in the aberrant right subclavian artery group. Although there were no significant differences in developmental history, gastrointestinal, or respiratory symptoms, neonates with aberrant right subclavian artery had a higher incidence of mild developmental delay and feeding difficulty than normal infants (21 versus 0%, p = 0.061; 36 versus 20%, p = 0.264, respectively). The growth rates of body length and weight during infancy were not significantly different between the two groups.
Echocardiography can be applied as a first-line investigation in the diagnostic work-up for aberrant right subclavian artery. Neonates with aberrant right subclavian artery had a smaller size at birth, although growth rates were not significantly different from those of normal infants. This study does not support an active surgical policy for asymptomatic infants with isolated aberrant right subclavian artery. A larger study and longer follow-up of affected infants is recommended.
右锁骨下动脉异常是最常见的先天性主动脉弓异常。关于经超声心动图筛查发现的这种先天性心脏病的临床表现和随访情况，已有一些报道。
对1737例足月儿进行了超声心动图筛查，男女比例为900:837。对有或无孤立性右锁骨下动脉异常的新生儿在婴儿期进行了研究。
在1737例病例中，共有15例（0.86%）以女性为主的新生儿存在孤立性右锁骨下动脉异常，男女比例为6:9。将他们与20例年龄和性别匹配的正常新生儿进行了比较。两组之间产妇年龄、孕周或产次均无显著差异，但出生大小（出生身长和体重的年龄百分位数，分别为p = 0.006和0.045）除外，右锁骨下动脉异常组的出生大小较小。虽然发育史、胃肠道或呼吸道症状方面无显著差异，但右锁骨下动脉异常的新生儿轻度发育迟缓及喂养困难的发生率高于正常婴儿（分别为21%对0%，p = 0.061；36%对20%，p = 0.264）。两组婴儿期身长和体重的生长速度无显著差异。
超声心动图可作为右锁骨下动脉异常诊断检查的一线方法。右锁骨下动脉异常的新生儿出生时体型较小，尽管生长速度与正常婴儿无显著差异。本研究不支持对无症状的孤立性右锁骨下动脉异常婴儿采取积极的手术策略。建议对受影响的婴儿进行更大规模的研究和更长时间的随访。
