Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Ann Thorac Surg. 2022 Feb;113(2):630-636. doi: 10.1016/j.athoracsur.2021.01.025. Epub 2021 Jan 29.
Fetal diagnoses of vascular rings have been increasing. We compared management strategies and outcomes of infants with fetal diagnosis with those with postnatal diagnosis to inform recommendations regarding optimal management.
A retrospective review was performed of vascular ring operations from January 2000 to June 2019. Standard demographic data (preoperative clinical status, timing of diagnosis, cross-sectional imaging, operative and perioperative details, and clinical outcomes) were collected. Statistical analysis was performed to compare characteristics and outcomes of fetal versus postnatal diagnosis.
Of 190 patients, 15% (n = 29) were diagnosed prenatally. Anatomic variants were double aortic arch (n = 66, 14 fetal diagnoses), right aortic arch, aberrant left subclavian artery (n = 94, 12 fetal diagnoses), circumflex aorta (n = 7, 1 fetal diagnosis), and pulmonary artery sling (n = 19, 2 fetal diagnoses). An increasing frequency of fetal diagnoses has been noted in the past 10 years. In 2012 1 of 9 patients (11%) had a fetal diagnosis, whereas in 2018 8 of 11 (72%) had a fetal diagnosis (P < .001). Patients with a fetal diagnosis were significantly younger at the time of surgery (13.1 months [interquartile range (IQR), 20.6] vs 24.0 months [IQR, 87.0], P = .029). There was no difference in postoperative complications or length of stay (3 days [IQR, 1] for fetal diagnoses vs 4 days [IQR, 3] for postnatal diagnoses, P = .50).
Fetal diagnosis leads to the potential for expectant management of vascular ring patients. This has resulted in earlier time of intervention with no increase in postoperative morbidity. This may lead to improved long-term outcomes and potentially alter the natural history for these children.
胎儿血管环的诊断越来越多。我们比较了胎儿诊断和产后诊断婴儿的治疗策略和结果，为最佳治疗方案提供建议。
回顾性分析 2000 年 1 月至 2019 年 6 月间的血管环手术。收集了标准的人口统计学数据（术前临床状况、诊断时间、横断面成像、手术和围手术期细节以及临床结果）。进行了统计学分析以比较胎儿与产后诊断的特征和结果。
在 190 例患者中，15%（n=29）为产前诊断。解剖变异包括双主动脉弓（n=66，14 例胎儿诊断）、右主动脉弓、左锁骨下动脉异常（n=94，12 例胎儿诊断）、回旋主动脉（n=7，1 例胎儿诊断）和肺动脉吊带（n=19，2 例胎儿诊断）。过去 10 年，胎儿诊断的频率呈上升趋势。2012 年，9 例患者中有 1 例（11%）为胎儿诊断，而 2018 年，11 例患者中有 8 例（72%）为胎儿诊断（P<.001）。胎儿诊断组手术时年龄明显较小（13.1 个月[四分位距（IQR），20.6] vs. 24.0 个月[IQR，87.0]，P=0.029）。术后并发症或住院时间无差异（胎儿诊断为 3 天[IQR，1]，产后诊断为 4 天[IQR，3]，P=0.50）。
胎儿诊断可使血管环患者有机会进行期待治疗。这导致干预时间更早，而术后发病率没有增加。这可能会改善长期预后，并可能改变这些儿童的自然病程。
