Prenatal diagnosis of aberrant right subclavian artery in an unselected population

Song, Mi Jin; Han, Byoung Hee; Kim, Young-Hwa; Yoon, So Young; Lee, Yoo Mi; Jeon, Hye Su; Park, Bo Kyung

doi:10.14366/usg.16046

Cited by 22 publications

(31 citation statements)

References 22 publications

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“…Of 57 studies identified through the electronic search and manual searching of references, 27 were assessed in full text, and of these, 14 were excluded (Table S2). Therefore, 13 studies, encompassing a total of 333 cases of isolated ARSA, were included in the review, of which seven involved retrospective and six prospective data acquisition (Table ).…”

Section: Resultsmentioning

confidence: 99%

Microarray analysis has no additional value in fetal aberrant right subclavian artery: description of 268 pregnancies and systematic literature review

Sagi‐Dain

Singer

Josefsberg

et al. 2019

Ultrasound in Obstet & Gyne

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Objectives Fetal aberrant right subclavian artery (ARSA) is a relatively common sonographic finding. Several studies have reported a significant association between ARSA and Down syndrome, as well as 22q11.2 microdeletion. The objective of this study was to assess the risk of abnormal chromosomal microarray analysis (CMA) findings in a large cohort of pregnancies with fetal ARSA as an isolated, as well as a non-isolated, sonographic anomaly. A secondary objective was to review the literature, examining the frequency of chromosomal microarray aberrations in fetuses with isolated ARSA.Methods Data from all pregnancies referred for invasive testing and CMA due to sonographic diagnosis of fetal ARSA, between 2013 and 2017, were obtained retrospectively from the computerized database of the Israeli Ministry of Health. The rate of clinically significant CMA findings in these fetuses was compared to that in a local control population of 2752 low-risk pregnancies with normal ultrasound and serum screening results. In addition, a literature search was conducted in PubMed, from inception to February 2018, of original studies in the English language describing the frequency and nature of microscopic and submicroscopic aberrations in fetuses with isolated ARSA. ResultsOf 246 pregnancies with isolated ARSA that underwent CMA analysis, a clinically significant finding was detected in one (0.4%) pregnancy (trisomy 21). This rate did not differ significantly from that in the control population (P = 0.1574). Of 22 fetuses with non-isolated ARSA, one (4.5%) additional case of trisomy 21 was noted. The frequency of trisomy 21 in this cohort also did not differ from that in the control population (relative risk, 5.5 (95% CI,). The literature search yielded 13 additional relevant papers, encompassing 333 cases of isolated ARSA. Of 579 cases overall (including those of the present study), 13 (2.2%) cases of trisomy 21 were detected, with no cases of 22q11.2 microdeletion. ConclusionWhile an association may exist between non-isolated ARSA and Down syndrome, isolated ARSA might better serve as a soft marker for Down syndrome, rather than a routine indication for invasive prenatal testing.

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Section: Resultsmentioning

confidence: 99%

Microarray analysis has no additional value in fetal aberrant right subclavian artery: description of 268 pregnancies and systematic literature review

Sagi‐Dain

Singer

Josefsberg

et al. 2019

Ultrasound in Obstet & Gyne

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show abstract

“…The ARSA was not confirmed postnatally. 20,21 and if the arch is a left arch, then there is a very low probability of a vascular ring. 22 Our conclusion is similar to other studies performed in different populations that have shown limited utility for a fetal ECHO following a normal AS.…”

Section: Discussionmentioning

confidence: 99%

“…Review of the images, including Doppler of the ARSA, retrospectively confirmed that the neonatal echocardiogram most likely overlooked this finding due to poor visualization, as a result of lung aeration in the neonate. Some would argue whether an ARSA is important to identify, as when isolated, there is a very low risk for aneuploidy, including trisomy 21 and deletion 22q.11, 20,21 and if the arch is a left arch, then there is a very low probability of a vascular ring 22 …”

Section: Discussionmentioning

confidence: 99%

Is a Fetal Echocardiography Necessary in IVF‐ICSI Pregnancies After Anatomic Survey?

Aderibigbe

Ranzini

2020

J of Clinical Ultrasound

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Purpose: In vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) is generally regarded as an indication for fetal echocardiography due to a reported increased risk of congenital abnormalities including cardiac anomalies. In this study we evaluated the utility of fetal echocardiography after anatomic survey in an experienced center.Methods: This was a retrospective case review of in vitro fertilization with intracytoplasmic sperm injection pregnancies who had echocardiography in our insti-Results: Records from 85 mothers and 110 fetuses were identified. During anatomic survey, six cardiac anomalies were identified, including four ventricular septal defects, one pulmonary-aortic disproportion, and one post-valvular pulmonary artery dilatation. At fetal echocardiography, two of the four ventricular septal defects were confirmed and an additional three were identified. The most common cardiac anomaly seen in our population of IVF-ICSI pregnancies was ventricular septal defect, which was identified in 3.6% of all cases in the neonatal period. Of ventricular septal defects identified in the prenatal period, 71% resolved before birth. Conclusion:In experienced centers, a fetal echocardiography may not be necessary if the 3 vessels tracheal view of the heart is evaluated and the heart is evaluated carefully for a ventricular septal defect. K E Y W O R D S cardiac abnormalities, fetal echocardiography, in vitro fertilization, IVF, intracytoplasmic sperm injection, ICSI

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“…There is a discrepancy in the reported prevalence of ARSA in cadaveric studies in comparison to that in prenatal ultrasound studies, possibly explained by insufficient prenatal detection of this condition. Two large-scale cadaveric studies have reported a prevalence of 1.23–2.2% [ 15 , 16 ], while prenatal ultrasound studies in unselected populations have reported a prevalence of only 0.4% [ 4 , 24 ]. A low ARSA prevalence was also found in additional prenatal studies [ 7 , 18 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

The “No ARSA” Sign: A Novel Method of Prenatal Screening for Aberrant Right Subclavian Artery

Kassif

Tsur

Shust-Barequet

et al. 2020

JCM

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An aberrant right subclavian artery (ARSA) can be overlooked by the conventional method as described by Chaoui et al., due to acoustic shadowing. The aim of this study was to evaluate the feasibility and accuracy of a novel screening method for ARSA by demonstrating the brachiocephalic artery bifurcation, referred to as the “No ARSA” sign. A prospective study conducted at a tertiary care center between 2018 and 2019 included unselected pregnant patients at a median gestational age of 15.1 (14.2–22.1; IQR (inter-quartile range)) weeks, who had been referred for a routine or targeted anomaly scan. All participants were scanned for the presence or absence of ARSA using both the conventional and the novel “No ARSA” methods for validation purposes. A total of 226 unselected patients were enrolled in the study. The “No ARSA” sign was visualized in 218 fetuses (96.5%). In the remaining 8 cases (3.5%), the “No ARSA” sign was not demonstrated. In these fetuses, an ARSA was visualized by the conventional method. The new method exhibited 100% feasibility and was in complete agreement with the conventional method. Intra- and inter-observer agreement was excellent (κ = 1). The results of the study suggest that the “No ARSA” sign is an efficient and reliable screening tool for ARSA.

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Prenatal diagnosis of aberrant right subclavian artery in an unselected population

Cited by 22 publications

References 22 publications

Microarray analysis has no additional value in fetal aberrant right subclavian artery: description of 268 pregnancies and systematic literature review

Microarray analysis has no additional value in fetal aberrant right subclavian artery: description of 268 pregnancies and systematic literature review

Is a Fetal Echocardiography Necessary in IVF‐ICSI Pregnancies After Anatomic Survey?

The “No ARSA” Sign: A Novel Method of Prenatal Screening for Aberrant Right Subclavian Artery

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