Prenatal diagnosis and surgical treatment of vascular rings
Vascular rings (VR) are a group of congenital anomalies of the vessels of the aortic arch (AA) that compress the trachea and the esophagus. It causes respiratory symptoms or problems with swallowing. In the period from 2012 to 2015 we diagnosed 28 cases of VR. The primary examination of pregnant women was conducted from the 20th to the 38th weeks of gestation. Right aortic arch with left ductus arteriosus and aberrant left subclavian artery (RAA, LDA, ALSA) was diagnosed in 24 cases. The double aortic arch (DAA) was diagnosed in 4 cases. Among the 28 diagnosis the VR was isolated in 20 and associated with other structural congenital heart disease (CHD) in 8 cases. The diagnosis of VR was took after 1 prenatal and 2 postnatal echocardiograms in 3 cases off. Two children died after birth from non-cardiac causes. Among the 23 diagnoseis the VR was confirmed on the computed tomography angiography (CTA) in 17 (73.9%) cases. However, the different anatomical variants of the VR was complete confirmed in 11 (64,71%) cases and a partial discrepancy was found in 6 (35,29%) cases. Six (26,1%) patients had no symptoms, therefore CT was postponed. Surgical treatment of VR was performed in 13 (56.52%) patients.
Articles and own analysis show that CT is the best method in diagnostics VR, but prenatal echocardiography can detect VR during pregnancy. It makes possible to make important additional examinations and helps to improve the treatment.
2. Congenital vascular rings: a clinical challenge for the pediatrician / Licari A., Manca E., Rispoli G. A. et al. // Pediatr. Pulmonol. – 2015. – Vol. 50. – P. 511.
3. Vascular Ring Diagnosis and Management: Notable Trends Over 25 Years / Evans W. N., Acherman R. J., Ciccolo M. L. et al. // World J Pediatr Congenit Heart Surg. – 2016 Nov. – Vol. 7 (6). – P. 717–720.
4. Prenatal Sonographic Features of a Double Aortic Arch: Literature Review and Perinatal Management / Trobo D., Bravo C., Alvarez T. et al. // J Ultrasound Med. – 2015 Nov. – Vol. 34 (11). – P. 1921–7. doi: 10.7863/ ultra.14.12076. Epub 2015 Oct 7.
5. Fetuses with right aortic arch: a multicenter cohort study and meta-analysis / D’Antonio F., Khalil A., Zidere V. et al. // Ultrasound Obstet Gynecol. – 2016 Apr. – Vol. 47 (4). – P. 423–32. doi: 10.1002/uog.15805. Epub 2016 Mar 16.
6. Prenatal diagnosis of vascular rings / Jain S., Kleiner B., Moon-Grady A. et al. // J Ultrasound Med. – 2010 Feb. – Vol. 29 (2). – P. 287–94.
7. Prenatal diagnosis and outcome of right aortic arch without significant intracardiac anomaly / Razon Y., Berant M., Fogelman R. et al. // J Am Soc Echocardiogr. – 2014 Dec. – Vol. 27 (12). – P. 1352–8.