Congenital aortic arch anomaly is usually found in association with other cardiovascular malformations or chromosomal anomalies. Double aortic arch (DAA) is an uncommon but significant type of aortic arch anomaly, and it may lead to compression of the trachea and esophagus by forming a complete vascular ring. Aortic arch anomalies occur in about 15% of patients with D-transposition of the great arteries (D-TGA) (Cui et al., 2007). Here we report an unusual case of combined D-TGA and DAA diagnosed by ultrasound fetal echocardiogram. To the best of our knowledge, this is the first reported case in the literature.A 27-year-old Chinese woman presented at our hospital for a routine prenatal ultrasound examination at 24 weeks of gestation, with an unremarkable pregnancy history. She had an insignificant past pregnancy history and denied any family history of congenital malformations or genetic disorders. The routine ultrasound examination revealed an otherwise healthy female fetus with an abnormal outflow tract in the heart. To further evaluate the abnormality, we performed a complete ultrasound cardiovascular examination, using a GE Voluson 730 Expert Ultrasound Machine and a 3.5 MHz linear transducer. The fetal heart was found to be normally sized and normally situated in the chest cavity, with an atrial situs solitus, atrioventricular concordance, and ventriculo-arterial discordance. The foramen ovale flap was seen in the left atrium. A small ventricular septal defect was identified in the four-chamber view, showing a left-to-right shunt in the systolic phase and a rightto-left shunt in the diastolic phase through the defect. The great arteries arose from the heart in an abnormally parallel arrangement, with the aorta arising anteriorly from the right ventricle and the pulmonary trunk arising posteriorly from the left ventricle. The aorta and the pulmonary trunk were normal in size, measuring 5 and 6 mm in diameter, respectively. In transverse sonogram, the ascending aorta was found to give rise to two symmetrical aortic arches with one on the left and the other on the right (Figure 1). Each aortic arch gave rise to a brachiocephalic artery divided into the common carotid artery and then the subclavian artery. Distal to the brachiocephalic branches, two aortic arches joined posteriorly to form a left-sided descending aorta. The remaining anatomy of the heart and the great vessels was normal. Flow patterns were normal in the mitral valve, tricuspid valve, inferior vena cava, ductus venosus, and umbilical vein, upon pulsed Doppler interrogation. The maximum velocity across the pulmonary and the aortic valve was 73 and 90 cm/s, respectively.To further evaluate the fetal anomaly, we did an amniocentesis followed by karyotyping. The fetus was found to have a normal karyotype (46,XX). After receiving the reports and information of a poor postnatal prognosis, the parents decided to terminate the pregnancy. A female fetus was delivered stillborn. A full body autopsy was done, which confirmed the prenatal diagnosis of DAA an...
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