Double aortic arch: implications of antenatal diagnosis, differential growth of arches during pregnancy, associated abnormalities and postnatal outcome

Abstract

This is the largest antenatal series of double aortic arch (DAA). It shows that in the vast majority of cases both arches are patent prenatally, but postnatally the left arch is atretic in most patients, supporting the theory of differential growth of the arches. Postnatal cases of DAA with atretic left can be misinterpreted as right aortic arch and thorough assessment by computed tomography (CT) is required. What are the clinical implications of this work?This work will help and guide antenatal counseling and postnatal management of cases of DAA. Based on our findings, the recommendation is for these patients to be delivered at hospitals where neonatal support is available, to have early postnatal pediatric cardiology review and to undergo CT irrespective of the presence of symptoms or not.

Three‐ and Four‐Dimensional Imaging of Ductus Arteriosus in Fetuses With Pulmonary Atresia and Aortic Arch Abnormalities

“…[Figure 1; online supplemental Video 1–3] Various signs (“V” and “U” signs) described in the literature do not adequately describe these anomalies 1 . Identification of the sidedness of the ductus arteriosus in relation to the aortic arch and its branches is important in fetuses with right aortic arch to predict a vascular ring 2 . Precise information of duct anatomy can also assist in planning neonatal ductal stenting in duct dependent pulmonary circulation especially in deciding vascular access (axillary artery) closer and coaxial to the ductus arteriosus.…”

“…1 Identification of the sidedness of the ductus arteriosus in relation to the aortic arch and its branches is important in fetuses with right aortic arch to predict a vascular ring. 2 Precise information of duct anatomy can also assist in planning neonatal ductal stenting in duct dependent pulmonary circulation especially in deciding vascular access (axillary artery) closer and coaxial to the ductus arteriosus. 3D/4D spatiotemporal image correlation imaging enables accurate identification of origin and course of ductus arteriosus in relation to the aortic arch.…”