To study the different characteristics of arterial duct (AD) in a series of prenatally detected right aortic arch (RAA). Out of 832 congenital heart diseases (CHD) referred to a tertiary center, 98 cases had RAA. Based on anatomical landmarks we identified 7 types of AD: type 1 left-sided, transverse; type 2 left-sided, vertical; type 3 from the underside of aortic arch (AA), vertical; type 4 right-sided, mirror-image “V”, transverse; type 5 right-sided, “H” shaped, transverse; type 6 bilateral; type 7 absent or unidentifiable. For each type of AD the incidence of associated major CHD was calculated and chi-square test was applied to verify the null hypothesis with significance level of p < 0.05. Type 1 occurred in 43% of cases including 4 with CHD and no cases with pulmonary outflow obstruction (POO). Symptoms of vascular ring were present in 41% of survivors. Type 2, 3 and 7 AD were associated with tetralogy of Fallot (TOF) or equivalents. No type 5 AD with CHD had POO and 3 isolated cases had asymptomatic hypoplasia of left pulmonary artery (LPA). Two type 6 AD had disconnection of LPA. Type 1 occurred more often as an isolated finding (p < 0.001), whereas types 2 (p = 0.0026), 3 (p = 0.0045), 4 (p = 0.0325) and 7 (p = 0.0001) were frequently associated with major CHD. In RAA, type 1 (U-shaped) is usually an isolated finding (p < 0.001) which includes all symptomatic vascular rings. POO is always present when the AD is vertical or absent but not when it lies on a transverse plane. Bilateral AD is rare and brings the risk of functionary loss of left lung if not identified.
Objectives: To predict neonatal outcome in cases with complete transposition of the great arteries (TGA) basing on foramen ovale (FO) morphology at fetal echocardiography. The primary outcome was the necessity of urgent Rashkind procedure. Methods: This was a retrospective cohort study. Patients referred to our tertiary centre for suspected complete TGA in a 12-year period.The following parameters were systematically obtained at fetal echocardiography at 34-37 weeks: presence of restrictive (FO), FO diameter, right atrium diameter. Neonatal follow-up was obtained through medical records analysis. Results: From November 2007 to April 2019, 71 fetuses with complete TGA were referred to our echocardiography laboratory. Of these, three were lost at follow up. Of the 68 remaining cases, 31 underwent urgent Rashkind procedure, 22 elective Rashkind procedure and 15 no procedure. Cases with restrictive FO had a significantly higher risk of urgent Rashking procedure compared with cases with normal FO (p < 0.05). Cases with smaller FO diameter and larger right atrium at fetal echocardiography had a significantly increased risk of urgent Rashkind procedure (p < 0.05). Conclusions: In cases with complete TGA a restrictive or narrow FO and a large right atrium at fetal echocardiography are associated with a worse neonatal outcome. OC01.02 The multiform spectrum of arterial duct in right aortic arch
Background Atrial electromechanical delay, assessed calculating the PA-TDI interval using tissue Doppler imaging, is a known and promising determinant for atrial fibrillation recurrence prediction after pulmonary vein isolation and electrical cardioversion. Purpose To determine the relationship between atrial electromechanical delay and the presence of atrial fibrillation. Methods We prospectively enrolled patients presenting at our Unit in sinus rhythm scheduled for an arrhythmogenic substrate ablation (atrial fibrillation -AF-, supraventricular tachycardia -SVT- and premature ventricular contractions -PVC-). Demographic and echocardiographic characteristics were evaluated upon admission. Atrial electromechanical delay was inferred via the PA-TDI interval, obtained by calculating the time difference between the P wave onset and the A" wave peak on TDI recordings. Results From October 2018 to August 2019, 200 patients (60% male, mean age 58,21 ± 14,26, mean BSA 1,9 ± 0,21 m2, mean BMI 26,42 ± 6,28 kg/m2, mean EF 60,91% ± 5,43%) were admitted to our unit to undergo AF (group 1: n = 145; 72,50%), SVT or PVC ablation (group 2: n = 55; 27,5%). Compared with the control group (group 2), patients admitted for AF ablation had a larger LA size (group 1 vs group 2: mean LA area 23,21 ± 5,07 vs 16,87 ± 4,01 cm2, p < 0,001; mean indexed LA volume 46,71 ± 20,41 ml vs 32,04 ± 14,7 ml, p < 0,001; mean LAD 41,77 ± 5,66 vs 33,84 ± 6,06, p < 0,001) and a longer PA-TDI interval (lateral 148,55 ± 28,5 vs 128,57 ± 20,9, p < 0,001; medial 125,34 ± 21,02 vs 109,11 ± 21,49, p < 0,001; average 141,43 ± 27,58 vs 119,08 ± 18,63, p < 0,001). Conclusion The PA-TDI interval is a non-invasive and easily achievable echocardiographic parameter, which is demonstrated to be prolonged in patients with a history of AF in contrast with patients with other arrhythmias, as expression of atrial conduction heterogeneity. Abstract Figure. PA-TDI measurement
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