Bakhru Shweta, Koneti Nageswara Rao, Patil Sujata, Dhulipudi Bhargavi, Dash Tapan, Kolar Geeta, Vavilala Suseela
Department of Pediatric Cardiology, Rainbow Children's Heart Institute, Hyderabad, Telangana, India.
Department of Fetal Medicine, Fernandez Hospital, Hyderabad, Telangana, India.
Ann Pediatr Cardiol. 2021 Jul-Sep;14(3):359-365. doi: 10.4103/apc.APC_108_20. Epub 2021 Feb 16.
Vascular rings (VRs) present with varied symptoms and may result in significant morbidity before an accurate diagnosis is made. Prenatal diagnosis may be useful to plan surgery after birth.
The purpose of the study was to see the feasibility of accurate diagnosis of VR during antenatal ultrasound examination and describe their outcome.
This is a retrospective observational study between January 2014 and December 2019. Vascular rings were diagnosed on the basis of three vessel tracheal view and neck vessels arrangements on fetal echocardiogram. Postnatal evaluation by transthoracic echocardiography and computerized tomography angiogram was performed. Surgical repair was done as per standard indications.
A total of 35 cases of fetal VRs (median gestational age: 24 weeks [range: 19-35]) were diagnosed during the study period. There were four dichorionic diamniotic twin gestation pregnancies. The right aortic arch (RAA) with anomalous left subclavian artery (ALSA) was suspected in 31 fetuses, double aortic arch (DAA) in 3, and circumflex aorta in 1. Twenty-six (74%) patients had successful deliveries. One patient had a spontaneous miscarriage, 2 underwent termination, and 6 were lost to follow-up. Postnatal assessment showed RAA with ALSA in 18, DAA in 5, circumflex aorta in 2, and no abnormality in 1. Twenty-two (86%) were operated (RAA with ALSA: 17, DAA: 4, and circumflex aorta: 1) and four were waiting for surgery. Two patients died due to prematurity-related complications. All survivors are symptom free during follow-up (median: 2.24; range: 0.2-5.6 years).
Fetal echocardiography enables prenatal diagnosis and planning of postnatal repair of VRs.
血管环（VRs）症状多样，在准确诊断之前可能导致严重发病。产前诊断可能有助于规划出生后的手术。
本研究的目的是观察产前超声检查准确诊断VRs的可行性并描述其结果。
这是一项2014年1月至2019年12月的回顾性观察研究。根据胎儿超声心动图上的三血管气管视图和颈部血管排列诊断血管环。通过经胸超声心动图和计算机断层血管造影进行产后评估。根据标准适应症进行手术修复。
在研究期间共诊断出35例胎儿VRs（中位孕周：24周[范围：19 - 35周]）。有4例双绒毛膜双羊膜囊双胎妊娠。31例胎儿疑似右位主动脉弓（RAA）伴异常左锁骨下动脉（ALSA），3例为双主动脉弓（DAA），1例为回旋主动脉。26例（74%）患者成功分娩。1例患者自然流产，2例终止妊娠，6例失访。产后评估显示18例为RAA伴ALSA，5例为DAA，2例为回旋主动脉，1例无异常。22例（86%）接受了手术（RAA伴ALSA：17例，DAA：4例，回旋主动脉：1例），4例等待手术。2例患者因早产相关并发症死亡。所有幸存者在随访期间均无症状（中位时间：2.24年；范围：0.2 - 5.6年）。
胎儿超声心动图能够实现VRs的产前诊断和产后修复规划。
