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Hu B, Li J, Li L, Yin H, Zheng C, Fan L. Neuro-Interventional Diagnosis and Treatment Using the Right Transradial Approach in Patients with Aberrant Right Subclavian Artery. World Neurosurg 2024; 185:e1330-e1337. [PMID: 38521216 DOI: 10.1016/j.wneu.2024.03.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To assess the effectiveness and safety of neurological interventions using the right transradial approach (R-TRA) in patients with aberrant right subclavian artery (ARSA). METHODS We retrospectively analyzed cases that underwent cerebral angiography and interventions at Huangpi District People's Hospital from January 2023 to July 2023. Out of 335 cases, 5 patients with ARSA were identified. RESULTS All 5 cases underwent diagnostic cerebral angiography via R-TRA. Two of the patients received interventions via R-TRA: 1 underwent right internal carotid artery balloon dilation angioplasty, while another underwent left vertebral artery stenting. No surgery-related complications were observed during these procedures. CONCLUSIONS R-TRA proves to be a safe and effective option for neuro-interventional surgery in patients with ARSA.
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Affiliation(s)
- Bin Hu
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Jing Li
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China.
| | - Liang Li
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Hao Yin
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Chong Zheng
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Liu Fan
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
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Goldmuntz E, Bassett AS, Boot E, Marino B, Moldenhauer JS, Óskarsdóttir S, Putotto C, Rychik J, Schindewolf E, McDonald-McGinn DM, Blagowidow N. Prenatal cardiac findings and 22q11.2 deletion syndrome: Fetal detection and evaluation. Prenat Diagn 2024. [PMID: 38593251 DOI: 10.1002/pd.6566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
Clinical features of 22q11.2 microdeletion syndrome (22q11.2DS) are highly variable between affected individuals and frequently include a subset of conotruncal and aortic arch anomalies. Many are diagnosed with 22q11.2DS when they present as a fetus, newborn or infant with characteristic cardiac findings and subsequently undergo genetic testing. The presence of an aortic arch anomaly with characteristic intracardiac anomalies increases the likelihood that the patient has 22q11.2 DS, but those with an aortic arch anomaly and normal intracardiac anatomy are also at risk. It is particularly important to identify the fetus at risk for 22q11.2DS in order to prepare the expectant parents and plan postnatal care for optimal outcomes. Fetal anatomy scans now readily identify aortic arch anomalies (aberrant right subclavian artery, right sided aortic arch or double aortic arch) in the three-vessel tracheal view. Given the association of 22q11.2DS with aortic arch anomalies with and without intracardiac defects, this review highlights the importance of recognizing the fetus at risk for 22q11.2 deletion syndrome with an aortic arch anomaly and details current methods for genetic testing. To assist in the prenatal diagnosis of 22q11.2DS, this review summarizes the seminal features of 22q11.2DS, its prenatal presentation and current methods for genetic testing.
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Affiliation(s)
- Elizabeth Goldmuntz
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anne S Bassett
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Erik Boot
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Advisium, 's Heeren Loo Zorggroep, Amersfoort, The Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Bruno Marino
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome (Italy), Roma, Italy
| | - Julie S Moldenhauer
- Division of Human Genetics, 22q and You Center, Clinical Genetics Center, Section of Genetic Counseling, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Obstetrics and Gynecology and Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sólveig Óskarsdóttir
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology and Immunology, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Carolina Putotto
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome (Italy), Roma, Italy
| | - Jack Rychik
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica Schindewolf
- Division of Human Genetics, 22q and You Center, Clinical Genetics Center, Section of Genetic Counseling, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Donna M McDonald-McGinn
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Human Genetics, 22q and You Center, Clinical Genetics Center, Section of Genetic Counseling, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Human Biology and Medical Genetics, Sapienza University, Rome, Italy
| | - Natalie Blagowidow
- The Harvey Institute for Human Genetics, Greater Baltimore Medical Center, Baltimore, Maryland, USA
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Geleta BE, Seyoum G. Prevalence and Patterns of Congenital Heart Defects and Other Major Non-Syndromic Congenital Anomalies Among Down Syndrome Patients: A Retrospective Study. Int J Gen Med 2024; 17:1337-1347. [PMID: 38596643 PMCID: PMC11001559 DOI: 10.2147/ijgm.s453181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/24/2024] [Indexed: 04/11/2024] Open
Abstract
Background Children with DS are at higher risk of developing congenital anomalies, particularly cardiac anomalies. Methods Medical records of 502 DS patients were reviewed. The logistic regression analyses were performed to determine independent predictors. Results Of the total 502 study subjects, 53.4% were males. Only 1.4% of the DS case diagnosis were confirmed by karyotyping. All cases were diagnosed postnatally. The median age at DS diagnosis was 5 months. About 13% were born preterm; 50.2% of the subjects maternal age at conception were thirty-five years and above. Over three-quarters (75.1%) had at least one structural congenital anomaly. Multiple anomalies were diagnosed in 12.8% of the subjects. At least one cardiac congenital anomaly was diagnosed in 67.3% of the study subjects, and 32.8% of them were diagnosed with multiple cardiac anomalies. Patent ductus arteriosus (28.5%), Ventricular septal defect (23.2%), and AVSD (21.9%) were the three common lesions. At least one genitourinary system anomaly was identified in 32 (6.4%) of them. Roughly, 8% of study participants exhibited congenital anomaly of the head, eye, nose, and throat. Anorectal malformation was found as the most common gastrointestinal anomaly. Maternal age at conception was found as independent predictor for presence of structural congenital anomaly (AOR 2.59; 95% CI 1.58-4.23, p-value < 0.01). Advanced maternal age is also found increasing the risk of developing congenital heart defect (AOR 2.37; 95% CI 1.52-3.7, p-value < 0.01). Conclusion High prevalence of congenital anomalies has been noted in the current study compared to previous studies. Predictive factors increasing risk of congenital anomalies in DS patients have been identified. The current findings may help in developing strategies and more targeted preventive and therapeutic interventions.
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Affiliation(s)
| | - Girma Seyoum
- Department of Anatomy, Addis Ababa University, Addis Ababa, Ethiopia
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Kaya M. Postnatal outcome of fetal aberrant right subclavian artery: a single center study. Arch Gynecol Obstet 2024:10.1007/s00404-024-07488-0. [PMID: 38555333 DOI: 10.1007/s00404-024-07488-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/16/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE This study aims to explore the correlation between fetal aberrant right subclavian artery (ARSA) and chromosomal disorders, with a specific focus on Down syndrome and DiGeorge syndrome. METHODS From November 2017 to February 2020, we conducted fetal anomaly screening and assessed the fetal heart in 8494 at our institution. The right subclavian artery tracing was assessed using Doppler ultrasonography following the 3-vessel and tracheal views (3VTV) in the fetal heart scan. RESULTS ARSA was found in 31 fetuses, which accounts for 0.36% of the total of 8494 fetuses. 96.8% of fetuses with ARSA were found to have normal chromosomal analysis. We identified only one case of trisomy 21 as the chromosomal condition present. In 80% of the identified ARSA, there were no additional associated findings. CONCLUSION ARSA is a rare condition that often does not manifest any concomitant abnormalities. The majority of ARSA instances identified in the second trimester are euploid. If ARSA is the only sonographic finding during fetal anomaly screening and there are no maternal or laboratory risk factors, further evaluation with non-invasive diagnostics may be recommended. Non-invasive genetic testing may be used for additional investigation.
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Affiliation(s)
- Murat Kaya
- Gaziantep City Hospital Radiology Department, University of Health Science, Ibn-I Sina District, 27470, Şahinbey/Gaziantep, Turkey.
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Axt-Fliedner R, Nazar A, Bedei I, Schenk J, Reitz M, Rupp S, Jux C, Wolter A. Associated Anomalies and Outcome in Patients with Prenatal Diagnosis of Aortic Arch Anomalies as Aberrant Right Subclavian Artery, Right Aortic Arch and Double Aortic Arch. Diagnostics (Basel) 2024; 14:238. [PMID: 38337754 PMCID: PMC10855084 DOI: 10.3390/diagnostics14030238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
We aimed to evaluate retrospectively associated anomalies and outcome in prenatal aortic arch anomalies (AAAs). We included ninety patients with aberrant right subclavian artery (ARSA), right aortic arch (RAA) with mirror image branching (RAA-mirror) or aberrant left subclavian artery (RAA-ALSA) and double aortic arch (DAA) between 2011 and 2020. In total, 19/90 (21.1%) had chromosomal anomalies, the highest rate being within the ARSA subgroup (17/46, 37%). All (13/13) of the RAA-mirror subgroup, 10/27 (37.0%) of RAA-ALSA, 13/46 (28.3%) of ARSA and 0/4 within the DAA subgroup had additional intracardiac anomaly. The rate of extracardiac anomalies was 30.7% in RAA-mirror, 28.3% in ARSA, 25.0% in DAA and 22.2% in the RAA-ALSA subgroup. A total of 42/90 (46.7%) had isolated AAAs: three (7.1%) with chromosomal anomalies, all trisomy 21 (3/26, 11.5%) within the ARSA subgroup. Out of 90, 19 (21.1%) were lost to follow-up (FU). Two (2.2%) intrauterine deaths occurred, and six (6.7%) with chromosomal anomalies terminated their pregnancy. In total, 63 (70.0%) were liveborn, 3/63 (4.8%) with severe comorbidity had compassionate care and 3/60 (5.0%) were lost to FU. The survival rate in the intention-to-treat cohort was 53/57 (93%). Forty-one (77.4%) presented with vascular ring/sling, two (4.9%) with RAA-ALSA developed symptoms and one (2.4%) needed an operation. We conclude that intervention due to vascular ring is rarely necessary. NIPT could be useful in isolated ARSA cases without higher a priori risk for trisomy 21 and after exclusion of other anomalies.
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Affiliation(s)
- Roland Axt-Fliedner
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Asia Nazar
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Ivonne Bedei
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Johanna Schenk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Maleen Reitz
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Stefan Rupp
- Department of Paediatric Cardiology, Children’s Hospital, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (S.R.); (C.J.)
| | - Christian Jux
- Department of Paediatric Cardiology, Children’s Hospital, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (S.R.); (C.J.)
| | - Aline Wolter
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
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Luo T, Liu S, Ran S, Dong H, Li Y, Ran Q. Associated congenital anomalies and genetic anomalies in fetuses with isolated and non-isolated aberrant right subclavian artery. J Matern Fetal Neonatal Med 2023; 36:2211705. [PMID: 37258285 DOI: 10.1080/14767058.2023.2211705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE This study's aim was to determine the prevalence of chromosomal anomalies in fetuses with isolated and non-isolated aberrant right subclavian artery (ARSA) and to evaluate its association with other congenital anomalies. METHODS From September 2018 to October 2021, 668 ARSA cases were diagnosed by prenatal ultrasound in our hospital; cases with missed visits and a lack of chromosomal findings were excluded and 363 cases were eligible for enrollment. General information, ultrasound presentation, chromosomal findings and pregnancy outcomes were retrospectively analyzed. RESULTS Among the 363 cases, 296 were isolated, and 67 were associated with structural abnormalities or soft marker abnormalities. The proportion of fetuses with chromosomal abnormalities in the isolated ARSA group was significantly lower than that in the non-isolated ARSA group (p < .001). In the non-isolated ARSA group, 22 cases were combined with other soft marker abnormalities and 45 cases were combined with structural abnormalities. The most frequent structural abnormality coexisting with ARSA was cardiac malformations (38.81%). CONCLUSION The most common combined malformation in ARSA is intracardiac malformation. Isolated ARSA has a low risk of chromosomal abnormalities, so invasive chromosomal testing is not recommended. Non-isolated ARSA has a high incidence of chromosomal abnormalities, so early karyotyping should be recommended.
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Affiliation(s)
- Tiantian Luo
- Department of Ultrasonics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Ultrasonics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Shuang Liu
- Department of Ultrasonics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Ultrasonics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Suzhen Ran
- Department of Ultrasonics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Ultrasonics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Hongmei Dong
- Department of Ultrasonics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Ultrasonics, Chongqing Health Center for Women and Children, Chongqing, China
| | - You Li
- Department of Ultrasonics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Ultrasonics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Qian Ran
- Department of Ultrasonics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Ultrasonics, Chongqing Health Center for Women and Children, Chongqing, China
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Li R, Qiu X, Shi Q, Wang W, He M, Qiao J, He J, Wang Q. Isolated aberrant right subclavian artery: an underlying clue for genetic anomalies. J Matern Fetal Neonatal Med 2023; 36:2183762. [PMID: 36860092 DOI: 10.1080/14767058.2023.2183762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Aberrant right subclavian artery (ARSA) is known to be associated with specific chromosomal abnormalities. However, there is no agreement regarding clinical decisions related to isolated ARSA. This study evaluated the association between ARSA and genetic abnormalities to provide evidence for prenatal consultation and the postpartum management of isolated ARSA. METHODS This single-center cross-sectional study involved fetuses diagnosed with ARSA between January 2014 and May 2021. A range of data was recorded for each patient, including screening ultrasound, fetal echocardiograms, genetic results, postnatal information, and follow-up records. RESULTS ARSA was detected in 151 fetuses, of which 136 were considered isolated cases. The remaining 9.9% (15/151) of cases had cardiac and/or extracardiac abnormalities or soft markers. Data from karyotype analysis and chromosomal microarray analysis (CMA) were available for 56 and 33 (out of 56) fetuses, respectively. Genetic abnormalities were detected in 10.7% of fetuses (6/56). Of these, 4.4% (2/45) and 36.4% (4/11) were associated with isolated and non-isolated ARSA, respectively, with a significant difference between these two groups regarding the frequency of genetic abnormality (p = 0.011). The analysis detected Klinefelter Syndrome (47, XXY) and 16p11.2 microdeletion in two isolated cases. One case each of trisomy 21 and 22q11.2 deletion, and another case of 47, XXY, were detected in fetuses with cardiac anomalies. Partial 5q deletion was found in a fetus with extracardiac malformations. In total, 141 of the fetuses survived after birth; termination of pregnancy was performed for 10 fetuses; only two fetuses had mild symptoms of dysphagia. CONCLUSION ARSA may be an underlying ultrasonic clue for genetic anomalies even in isolated ARSA. Fetuses with isolated ARSA cannot be ruled out for invasive antenatal diagnosis.
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Affiliation(s)
- Rui Li
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xia Qiu
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Qi Shi
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Wan Wang
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Mei He
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing Qiao
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing He
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Qi Wang
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Xue H, Zhang L, Yu A, Lin M, Guo Q, Xu L, Huang H. Prenatal genetic analysis of fetal aberrant right subclavian artery with or without additional ultrasound anomalies in a third level referral center. Sci Rep 2023; 13:3414. [PMID: 36854820 PMCID: PMC9975173 DOI: 10.1038/s41598-023-30598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
To evaluate the correlation between chromosomal abnormalities and fetal aberrant right subclavian artery (ARSA) with or without additional ultrasound anomalies (UAs). A total of 340 fetuses diagnosed with ARSA by ultrasound between December, 2015, and July, 2021, were included. All cases were subdivided into three groups: (A) 121 (35.6%) cases with isolated ARSA, (B) 91 (26.8%) cases with soft markers, and (C) 128 (37.6%) cases complicated with other UAs. Invasive testing was performed via amniotic fluid or cord blood karyotyping and chromosomal microarray analysis (CMA) in parallel, and pregnancy outcomes were followed. Karyotype abnormalities were identified in 18/340 (5.3%) patients. Karyotype abnormalities in Groups A, B, and C were 0/121 (0.0%), 7/91 (7.7%), and 11/128 (8.6%), respectively. CMA abnormalities with clinically significant variants were detected in 37/340 (10.9%) cases, of which 22q11.2 deletion syndrome and trisomy 21 accounted for 48.6% (18/37). The overall abnormal CMA with clinically significant variant detection rates in Groups A, B, and C were 3/121(2.5%), 13/91 (14.3%), and 21/128 (16.4%), respectively. There were significant difference in clinically significant CMA anomalies detection rate between Groups A and C (p < 0.05), as well as Groups A and B (p < 0.05). Comparing CMA to karyotyping showed a clinically significant incremental yield in Group C (7.8%, 10/128) compared to Groups A (2.5%, 3/121) and B (6.6%, 6/91) (p > 0.05). Fetal ARSA with additional UAs, concurred with cardiac and extra-cardiac anomalies, constitutes a high-risk factor for chromosomal aberrations, especially for pathogenic or likely pathogenic copy number variants.
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Affiliation(s)
- Huili Xue
- Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fuzhou City, 350001, Fujian Province, China.
| | - Lin Zhang
- grid.256112.30000 0004 1797 9307Fujian Medical University, No. 88 Jiaotong Road, Cangshan District, Fuzhou City, 350001 Fujian Province China
| | - Aili Yu
- grid.256112.30000 0004 1797 9307Reproductive Medicine Center, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Min Lin
- grid.256112.30000 0004 1797 9307Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Qun Guo
- grid.256112.30000 0004 1797 9307Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Liangpu Xu
- grid.256112.30000 0004 1797 9307Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Hailong Huang
- grid.256112.30000 0004 1797 9307Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
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Annetta R, Nisbet D, O’Mahony E, Palma-Dias R. Aberrant right subclavian artery: embryology, prenatal diagnosis and clinical significance. Ultrasound 2022; 30:284-291. [PMID: 36969537 PMCID: PMC10034652 DOI: 10.1177/1742271x211057219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
Introduction The right subclavian artery normally arises as the first vessel from the brachiocephalic trunk. An aberrant right subclavian artery (ARSA) arises directly from the aortic arch and crosses behind the trachea towards the right arm. This variant occurs in approximately 1-2% of the population; however, the frequency increases in individuals with chromosomal abnormalities such as trisomy 21 and 22q11.2 microdeletion. Prenatal identification of ARSA therefore has a role in screening for such conditions. Methods Databases were searched for studies reporting the prenatal ultrasound evaluation of ARSA and its frequency in normal fetuses and in those with chromosomal abnormalities. Results A total of 23 studies were evaluated. Feasibility for the ultrasound evaluation of ARSA was 85-95%. The sonographic detection of ARSA is best in the three-vessel trachea view; however, sagittal and coronal imaging of the aortic arch may be useful. ARSA in isolation was not found to be associated with chromosomal abnormalities. The prevalence of ARSA in chromosomally abnormal fetuses was up to 24-fold higher than in normal fetuses, but the majority of chromosomally abnormal fetuses with ARSA had additional abnormal ultrasound findings, particularly cardiac abnormalities. Conclusions The prenatal detection of ARSA is a clinically useful prenatal marker for chromosomal abnormalities. In isolation, it is unlikely to be associated with pathogenic genetic variants. The ultrasound diagnosis of ARSA should prompt meticulous assessment of associated abnormalities. Invasive diagnostic testing should be offered to patients with non-isolated ARSA or in the presence of non-reassuring screening results or other risk factors.
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Affiliation(s)
| | - Debbie Nisbet
- Royal Women’s Hospital, Melbourne, Victoria, Australia
| | | | - Ricardo Palma-Dias
- Royal Women’s Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of
Melbourne, The University of Melbourne, The Royal Women’s Hospital,
Parkville, Victoria, Australia
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Sun H, Han L, Hao X, Chen Z, Wang J, Yi T, Zhou X, Gu X, Han J, Zhang Y, Sun L, Liu X, Zhang S, Guo Y, Zhang H, He Y. Genetic abnormalities in fetal congenital heart disease with aberrant right subclavian artery. Sci Rep 2022; 12:15899. [PMID: 36151134 PMCID: PMC9508080 DOI: 10.1038/s41598-022-20037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 09/07/2022] [Indexed: 11/27/2022] Open
Abstract
Fetal aberrant right subclavian artery (ARSA) is a relatively common sonographic finding. Congenital heart disease (CHD) is the most common structural abnormality in patients with ARSA. We aimed to assess the prevalence of genetic abnormalities, particularly sequence variants, in fetuses with CHD and ARSA. By clinical phenotyping and genomic sequencing, we retrospectively reviewed all fetuses with a prenatal diagnosis of CHD combined with ARSA at a single center. As a result, we identified 30 fetuses with ARSA combined with CHD, with conotruncal anomalies being the most common (n = 12, 40%), followed by left ventricular outflow tract obstruction (n = 6, 20%) and atrioventricular septal defects (n = 6, 20%). Overall, 18 (60%) cases had a genetic diagnosis. Copy number variation sequencing analysis identified six (20%) fetuses with aneuploidy and seven (23%) with pathogenic copy-number variants. Whole-exome sequencing (WES) analysis of the remaining 17 cases revealed diagnostic genetic variants in five (29%) cases, indicating that the diagnostic yield of WES for the entire cohort was 17% (5/30). Our findings reveal the high burden of genetic abnormalities in fetal CHD with ARSA. Single-gene disorders contribute substantially to the genetic etiology of fetal CHD with ARSA.
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Affiliation(s)
- Hairui Sun
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Lu Han
- Department of Cardiac Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Hao
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Zhaoyi Chen
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jingyi Wang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Tong Yi
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xiaoxue Zhou
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xiaoyan Gu
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jiancheng Han
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Ye Zhang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Lin Sun
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xiaowei Liu
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Siyao Zhang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yong Guo
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Hongjia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Yihua He
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China.
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Chen L, Wang L, Wang Y, Hu H, Zhan Y, Zeng Z, Liu L. Global, Regional, and National Burden and Trends of Down Syndrome From 1990 to 2019. Front Genet 2022; 13:908482. [PMID: 35910218 PMCID: PMC9337874 DOI: 10.3389/fgene.2022.908482] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Down syndrome (DS) is the leading cause of genetically defined intellectual disability and congenital birth defects worldwide. A large population of people diagnosed with DS globally is posing an enormous socioeconomic burden. However, the global burden and trends of DS have not been reported. Methods: Based on the data from the Global Burden of Disease database in 2019, we analyzed the incidence, prevalence, disability-adjusted life years (DALYs), and death of DS from 1990 to 2019 according to sex, age, regions, and social-demographic index (SDI). Then, age-standardized rates (ASRs) and estimated annual percentage change (EAPC) of these aforementioned indexes were calculated to evaluate the temporal trend of DS. Finally, the association of SDI with DS epidemiological parameters was assessed. Results: In the past 30 years, the incident cases, age-standardized incident rate (ASIR), and age-standardized prevalent rate (ASPR) of DS first decreased slightly and subsequently increased globally. The number of prevalent cases increased steadily, while the number and age-standardized rate (ASRs) of DALYs and deaths decreased gradually from 1990 to 2019. In the meantime, disease burdens were different across various SDI regions. The prevalent cases and ASPR for both sexes were increasing in all SDI regions except for the high-middle SDI region. At the national level, Brunei Darussalam, Ireland, and Haiti were the top three countries with the highest ASIR in 2019. Georgia was in the top three with the highest increase in ASRs of four parameters, while Serbia was consistently ranked in the top three with fastest declining. Furthermore, we found that ASIR and ASPR were positively correlated with SDI, yet the age-standardized DALYs and age-standardized death rate (ASDR) were negatively correlated with SDI. Conclusion: In the past 30 years, the burden and trends of DS were heterogeneous across different regions and countries with different sociodemographic characteristics. Great improvements had been achieved in reducing DALYs and deaths globally. However, the increased number and ASRs of incident and prevalent cases in some regions, especially in low SDI regions, were contributing to numerous challenges to public health. The findings may provide valuable information to the development or implementation of more effective measures.
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Affiliation(s)
- Liyuan Chen
- Department of Obstetrics and Gynecology, Wuhan No 1 Hospital, Wuhan, China
| | - Lifei Wang
- Department of Obstetrics and Gynecology, Wuhan No 1 Hospital, Wuhan, China
| | - Yi Wang
- Second Clinical College, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haishan Hu
- Department of Reproductive Medicine, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Wuhan, China
| | - Yuan Zhan
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhilin Zeng
- Department and Institute of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lidan Liu
- Department of Obstetrics and Gynecology, Wuhan No 1 Hospital, Wuhan, China
- *Correspondence: Lidan Liu,
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Stavridis K, Antsaklis P, Theodora M, Tasias K, Daskalakis G. Prenatal diagnosis of aberrant right subclavian artery: a literature review. J Matern Fetal Neonatal Med 2022; 35:8856-8862. [PMID: 35156496 DOI: 10.1080/14767058.2021.2005570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The primary aim of this review is to estimate the prevalence of ARSA both in euploid fetuses as well as in fetuses with Down Syndrome. Secondary objectives were to estimate the association of ARSA with cardiac anomalies and chromosomal defects, especially trisomy 21 and 22q11 deletion (DiGeorge Syndrome). The incidence of ARSA in normal population varies from 0.35% to 3.5%, based on different studies. Since the first reported association between ARSA and trisomy 21 in 2015 until today, several studies have emerged to confirm different degrees of this correlation. Indeed, ARSA appears to be a clinically useful prenatal ultrasound marker for trisomy 21. Particularly, most recent studies concluded that ARSA as a non-isolated finding can be used as screening for Down syndrome. However, when ARSA is an isolated finding, various studies proved that there is no significant correlation with Down syndrome. Apart from these, ARSA appears to be associated with other chromosomal abnormalities, such as 22q11 deletion, cardiac defects and other morphological anomalies. As a conclusion ARSA should be characterized as isolated or non-isolated, as the non - isolated ARSA appears to be a clinically useful marker of Down syndrome and thus, additional testing is required when diagnosed.
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Affiliation(s)
| | - Panos Antsaklis
- First Department of Obstetrics and Gynecology, University of Athens, Athens, Greece
| | - Marianna Theodora
- First Department of Obstetrics and Gynecology, University of Athens, Athens, Greece
| | - Konstantinos Tasias
- First Department of Obstetrics and Gynecology, University of Athens, Athens, Greece
| | - Georgios Daskalakis
- First Department of Obstetrics and Gynecology, University of Athens, Athens, Greece
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Topbas Selcuki NF, Senol G, Esin D, Ozkose ZG, Caypinar SS, Bornaun H, Cetin BA, Yuksel MA. Prenatal diagnosis and postnatal outcomes of right aortic arch anomalies. Arch Gynecol Obstet 2022; 306:745-752. [PMID: 34981204 DOI: 10.1007/s00404-021-06346-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 11/22/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE To give a report on the experience of our tertiary perinatology clinic on the pre- and postnatal management of the right aortic arch (RAA) by evaluating the patients as isolated and non-isolated RAA. MATERIALS AND METHODS Patients referred to our perinatology clinic for fetal echocardiography were evaluated retrospectively. They were assessed in two groups: isolated RAA and non-isolated RAA. The isolated RAA group consisted of patients without any additional cardiac or extracardiac anomalies. According to our routine practice, all patients received detailed prenatal ultrasonography following fetal echocardiography and genetic counseling. RESULTS A total of 60 patients were evaluated. 38 patients (63.3%) presented with additional cardiac anomalies. 21.7% had extracardiac anomalies, including 16.7% who also had cardiac anomalies. In 2 patients (3.7%) 22q11.2 microdeletion, in 2 patients (3.7%) trisomy 21, in 1 patient (1.9%) trisomy 13 and in 1 patient (1.9%) 20p12.1p11.23 (a deletion of 2880 kbp) were reported. The most common cardiac anomaly associated with RAA was Tetralogy of Fallot (25%). Fetal growth restriction was reported in 8.3% of the cases. 18 patients had isolated RAA. 16 out of the 18 patients had normal genetic analysis. 2 of them (11.11%) presented with a 22q11.2 microdeletion. CONCLUSION A single-center experience on the diagnosis and management of RAA has been reported in this study. The results indicate that a prenatal cardiac evaluation in 3VV is of utmost importance in all pregnancies to detect RAA and refer these patients to the appropriate perinatology clinics for further evaluation and care.
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Affiliation(s)
- Nura Fitnat Topbas Selcuki
- Department of Obstetrics and Gynecology, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Kazim Karabekir Pasa, Bahcekoy Cd. No:64 D:64, 34453, Sariyer, Turkey.
| | - Gokalp Senol
- Department of Obstetrics and Gynecology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Didem Esin
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Zeynep Gedik Ozkose
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Sema Suzen Caypinar
- Department of Perinatology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Helen Bornaun
- Department of Pediatric Cardiology, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Berna Arslan Cetin
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Mehmet Aytac Yuksel
- Department of Obstetrics and Gynecology, Beykent University, Istanbul, Turkey
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Cai M, Lin N, Fan X, Chen X, Xu S, Fu X, Xu L, Huang H. Fetal Aberrant Right Subclavian Artery: Associated Anomalies, Genetic Etiology, and Postnatal Outcomes in a Retrospective Cohort Study. Front Pediatr 2022; 10:895562. [PMID: 35722491 PMCID: PMC9203729 DOI: 10.3389/fped.2022.895562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Aberrant right subclavian artery (ARSA) is becoming increasingly common in fetuses. However, there are relatively fewer studies regarding the genetic etiology of ARSA. We performed a genetic analysis of fetuses with ARSA and followed up on the pregnancy outcomes to evaluate the prognosis of the fetuses, providing information for prenatal and eugenic consultations. METHODS This retrospective study included 112 pregnant females whose fetuses were diagnosed with ARSA from December 2016 to February 2021. Fetal karyotype analysis and single-nucleotide polymorphism (SNP) array were performed. RESULTS The 112 fetuses were divided into two groups: the isolated ARSA group (n = 48, 42.9%) and the non-isolated ARSA group (ARSA with other ultrasound abnormalities, n = 64, 57.1%). The total rate of pathogenic copy number variation (CNV) observed using karyotype analysis (3/8) and SNP array (5/8) was 7.1% (8/112). The rates of pathogenic CNV in the isolated and non-isolated ARSA groups were 4.2% (2/48) and 9.4% (6/64), respectively. No significant difference was observed between the two groups (P = 0.463). The results of genetic analysis influenced the parents' decision to terminate the pregnancy. During the follow-up examination, fetuses with ARSA without pathogenic CNV were found to have normal growth and development after birth. CONCLUSION Fetuses with isolated ARSA have a low probability of being diagnosed with pathogenic CNV. However, when ARSA is complicated with other ultrasound abnormalities, the risk of pathogenic CNV remarkably increases. Prenatal genetic counseling and SNP-array should be recommended for better assessment of fetal prognosis.
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Affiliation(s)
- Meiying Cai
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Na Lin
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Xiangqun Fan
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Xuemei Chen
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Shiyi Xu
- Guangxi Medical University, Guangxi, China
| | - Xianguo Fu
- Department of Prenatal Diagnosis, Ningde Municipal Hospital, Ningde Normal University, Ningde, China
| | - Liangpu Xu
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Hailong Huang
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
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15
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Martínez-payo C, Suanzes E, Gómez-manrique A, Arranz A, Pérez-medina T. Aberrant right subclavian artery as soft marker in the diagnosis of trisomy 21 during the first trimester of pregnancy. Arch Gynecol Obstet. [PMID: 34550447 PMCID: PMC9166867 DOI: 10.1007/s00404-021-06221-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Purpose Aberrant right subclavian artery is an anatomical variation with a prevalence of around 0.5–1.5% of the general population, being more frequently found among people with chromosomopathies, especially, trisomy 21. Despite being an anatomical finding, and thus, constant through the whole pregnancy, its value in the diagnosis of aneuploidies during the first trimester of pregnancy has been little studied. The aim of this study is to evaluate the reliability of the first-trimester ultrasound in the diagnosis of ARSA and its utility in the early diagnosis of aneuploidies. Methods This was a descriptive, observational, cross-sectional study that included all fetuses with sonographic diagnosis of ARSA between 2011 and 2018. Results There were 257 cases of ARSA diagnosed. The first-trimester ultrasound showed the following results in the detection of ARSA: sensitivity of 68% (CI 95% 60.8%–74.5%), specificity of 99.9% (CI 95% 99.9%–100%), positive predictive value of 93.7% (CI 95% 88.1%–96.8%), and negative predictive value of 99.6% (CI 95% 99.5%–99.7%). Due to the presence of ARSA, two cases of trisomy 21, that would have been missed in the first trimester, were diagnosed, using ARSA as a soft marker and modifying the risk obtained by the combined screening as part of the genetic sonogram of the first trimester. Conclusions ARSA visualization during the first-trimester ultrasound is trustworthy and it can improve the detection of trisomy 21 in some cases of aneuploidy missed during the combined screening of the first trimester.
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Lourenço CSFP, Carriço AL, Valente FMDS. Prenatal Diagnosis of Aberrant Right Subclavian Artery: Association with Genetic Abnormalities. Rev Bras Ginecol Obstet 2021; 43:452-456. [PMID: 34318470 PMCID: PMC10411214 DOI: 10.1055/s-0041-1732461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/05/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The objective of the present study was to determine the frequency of malformations and chromosomal abnormalities in a population of fetuses with an aberrant right subclavian artery (ARSA). METHODS This is a 6-year retrospective study of fetuses with a prenatal diagnosis of ARSA conducted during the period between September 2013 and June 2019 at a fetal medicine unit. Data were collected from ultrasound, fetal echocardiograms, genetic studies, and neonatal records. RESULTS An ARSA was diagnosed in 22 fetuses. An ARSA was an isolated finding in 18 out of 22 cases (82%). Associated abnormal sonographic findings were found in 4 cases. All cases underwent invasive testing. In 1 of the cases, a chromosomal abnormality was detected (mos 45,X [13]/46,X,e(X) (p22.1q22.1)). No cases of congenital heart disease were found in any of these fetuses. There were two cases in which the postnatal evaluation revealed a malformation: one case of hypospadias and 1 case of cleft palate. CONCLUSION The presence of an isolated ARSA is benign and is not associated with chromosomal abnormalities. The finding of ARSA, however, warrants a detailed fetal ultrasound in order to exclude major fetal abnormalities and other soft markers.
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Affiliation(s)
| | - Ana Luísa Carriço
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Morlando M, Morelli C, Del Gaizo F, Fusco A, De Fazio F, Di Pietto L, Moccia G, Spinelli Barrile L, Schiattarella A, De Franciscis P, Colacurci N, Russo MG. Aberrant right subclavian artery: the association with chromosomal defects and the related post-natal outcomes in a third level referral centre. J OBSTET GYNAECOL 2021; 42:239-243. [PMID: 34039241 DOI: 10.1080/01443615.2021.1904228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aberrant right subclavian artery (ARSA) is the most common embryologic abnormality of the aortic arch. The presence of ARSA has been previously associated with an increased risk of Down syndrome. ARSA at birth may be associated with dysphagia, respiratory distress and stridor and there is no clear evidence-based management. The aim of this study was to describe the associations with chromosomal abnormalities and the postnatal outcome of fetuses diagnosed with ARSA. We analysed fetuses diagnosed antenatally with ARSA between January 2013 and September 2019 in the fetal echocardiography unit of the Hospital Monaldi, University 'Vanvitelli' of Naples, Italy. The results showed fifty fetuses diagnosed with ARSA, all confirmed after birth. The ARSA was an isolated finding in 46 fetuses (92%), while in 4 fetuses the ARSA was associated with other cardiac and/or extra-cardiac anomalies. Only one fetus was diagnosed with trisomy 21 (2%). In this fetus the ARSA was the only ultrasound anomaly identified. There were no cases necessitating referral due to the presence of compression symptoms at birth. The presence of ARSA was associated with trisomy 21 in the 2% of cases in our series and there were no neonatal complications due to airway compression at birth.IMPACT STATEMENTWhat is already known on this subject? Aberrant right subclavian artery (ARSA) is the most common embryologic abnormality of the aortich arch. ARSA at birth could be associated with dysphagia, respiratory distress and stridor and no evidence-based management of these fetuses has been described yet. The presence of ARSA has been previously associated with an increased risk of Down syndrome.What do the results of this study add? This study confirms known data on association with chromosomal defects and provides some original data on the absence of symptomatology due to tracheal compression with a postnatal follow-up up to three years of age.What are the implications of these findings for clinical practice and/or further research? Our findings suggest that in cases with adequate prenatal assessment performed by experienced clinicians, delivery can safely take place at local hospitals, with no need of referral soon after birth. The use of transthoracic echocardiography to confirm the diagnoses of ARSA after birth and to plan the next follow-up appointments can be supported.
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Affiliation(s)
- Maddalena Morlando
- Prenatal diagnosis and high-risk pregnancy unit, Department of Woman, Child and General and Specialised Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carmela Morelli
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
| | - Fortuna Del Gaizo
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
| | - Adelaide Fusco
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
| | - Federica De Fazio
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
| | - Laura Di Pietto
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
| | - Gianfranco Moccia
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
| | | | - Antonio Schiattarella
- Prenatal diagnosis and high-risk pregnancy unit, Department of Woman, Child and General and Specialised Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale De Franciscis
- Prenatal diagnosis and high-risk pregnancy unit, Department of Woman, Child and General and Specialised Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Colacurci
- Prenatal diagnosis and high-risk pregnancy unit, Department of Woman, Child and General and Specialised Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology Unit, Monaldi Hospital, University "Luigi Vanvitelli", Naples, Italy
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Chen LP, Lai YF, Zhong XH, You JH, Chen JH, Xie JX, Chen XK, Chen XY, Lyu GR. Predictive value of aberrant right subclavian artery for fetal chromosome aneuploidy in women of advanced maternal age. BMC Pregnancy Childbirth 2021; 21:148. [PMID: 33602166 PMCID: PMC7893932 DOI: 10.1186/s12884-021-03626-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 02/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background In the entire population, an aberrant right subclavian artery (ARSA) is closely associated with chromosomal abnormalities. ARSA with additional ultrasonic findings would increase risk of chromosomal abnormalities. The risk of fetal chromosomal abnormalities increased exponentially with the maternal age. These risks in the advanced maternal age (AMA) group are uncertain. This study aimed to determine the incidence of ARSA in Chinese AMA and non-AMA women and the frequency of aneuploidy among AMA and non-AMA women with ARSA. Methods This retrospective study included 13,690 singleton pregnancies, were divided into AMA and non-AMA groups. Integrated obstetric ultrasonic screening, biochemical screening, noninvasive prenatal screening, and fetal karyotype analysis were analyzed. Results The overall incidence of ARSA was 0.69%, with no difference between age groups. The incidence of chromosomal abnormalities in the AMA group (37 / 2860) was much higher than that of the non-AMA group. The risk of chromosomal abnormalities significantly increased with both ARSA detected and additional ultrasound findings. With combined ARSA and AMA, the likelihood of the incidence of chromosomal abnormalities increased. Chimerism (45X / 46XX) was found with isolated ARSA in AMA pregnancies. Conclusion There is a high prevalence of chromosomal abnormalities in fetuses of AMA women. ARSA increases the risk of chromosomal abnormalities in both age groups, especially combined with ARSA. When ARSA occurs in AMA women, it confers a high likelihood of chromosomal abnormalities.
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Affiliation(s)
- Li-Ping Chen
- Department of Ultrasound, Women and Children's Hospital, School of Medicine, Xiamen University, NO. 10 Zhenhai Road, Siming District, Xiamen, 361000, Fujian, People's Republic of China
| | - Yong-Feng Lai
- Department of Ultrasound, Wuping County Hospital, Longyan, 364300, Fujian, People's Republic of China
| | - Xiao-Hong Zhong
- Department of Ultrasound, Women and Children's Hospital, School of Medicine, Xiamen University, NO. 10 Zhenhai Road, Siming District, Xiamen, 361000, Fujian, People's Republic of China.
| | - Jian-Hong You
- Department of Ultrasound, Zhongshan Hospital of Xiamen University, Xiamen, 361000, Fujian, People's Republic of China.
| | - Jiang-Hua Chen
- Department of Ultrasound, Zhongshan Hospital of Xiamen University, Xiamen, 361000, Fujian, People's Republic of China
| | - Jing-Xian Xie
- Department of Obstetrics and Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, People's Republic of China
| | - Xiao-Kang Chen
- Department of Ultrasound, Children's Hospital of Fudan University Xiamen Branch, Xiamen Children's Hospital, Xiamen, 361000, Fujian, People's Republic of China
| | - Xiao-Yan Chen
- Department of Ultrasound, Zhongshan Hospital of Xiamen University, Xiamen, 361000, Fujian, People's Republic of China
| | - Guo-Rong Lyu
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, 362000, Fujian, People's Republic of China
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Ayaz R, Göktas E, Turkyilmaz G, Asoglu MR. PRENATAL IDENTIFICATION OF ABERRANT RIGHT SUBCLAVIAN ARTERY IN ISOLATION: THE NEED FOR FURTHER GENETIC WORK-UP? Acta Clin Croat 2020; 59:582-589. [PMID: 34285428 PMCID: PMC8253070 DOI: 10.20471/acc.2020.59.04.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to evaluate the association between aberrant right subclavian artery (ARSA) and chromosomal abnormalities. The study included 5211 women having attended our unit for fetal anatomic screening and fetal echocardiography from August 2016 until February 2019. After diagnosing ARSA, prenatal invasive testing was discussed with the patients. ARSA affected fetus was determined in 57 cases; of these, there were 38 cases of isolated ARSA and 19 cases of non-isolated ARSA but associated with soft markers and fetal anomalies. Nineteen patients underwent amniocentesis; Down syndrome was determined in two women, both of them from the non-isolated ARSA group, with fetal hydrops, atrioventricular septal defect and esophageal atresia. Fifteen of 38 patients who declined prenatal diagnostic testing, accepted karyotype analysis after delivery and none of these 15 cases had chromosomal abnormalities. Identification of ARSA should be followed by detailed ultrasound examination to ensure that there are no accompanying soft markers and/or structural defects. Isolated ARSA may not be an indication for karyotype analysis or 22q11.2 microdeletions. Non-ARSA implies a strong predictor of aneuploidy, and when additional findings are detected, invasive testing should be offered to the parents. The association between isolated ARSA and genetic disease should be evaluated in large powered prospective studies.
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Affiliation(s)
| | - Emine Göktas
- 1Division of Perinatology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey; 2Division of Genetic Disease, Van Regional Training and Research Hospital, Van, Turkey; 3Division of Obstetrics & Gynecology, Van Regional Trainingand Research Hospital, Van, Turkey; 4Bahceci Infertility and IVF Center, Fulya, Istanbul, Turkey
| | - Gurcan Turkyilmaz
- 1Division of Perinatology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey; 2Division of Genetic Disease, Van Regional Training and Research Hospital, Van, Turkey; 3Division of Obstetrics & Gynecology, Van Regional Trainingand Research Hospital, Van, Turkey; 4Bahceci Infertility and IVF Center, Fulya, Istanbul, Turkey
| | - Mehmet Resit Asoglu
- 1Division of Perinatology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey; 2Division of Genetic Disease, Van Regional Training and Research Hospital, Van, Turkey; 3Division of Obstetrics & Gynecology, Van Regional Trainingand Research Hospital, Van, Turkey; 4Bahceci Infertility and IVF Center, Fulya, Istanbul, Turkey
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20
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Martínez-Payo C, Suanzes E, Nieto-Jiménez Y, Ruiz de Azúa M, Siles A, Usano AI, Pérez-Medina T. Is it useful to evaluate the presence of aberrant right subclavian artery in prenatal diagnosis ultrasounds? J Obstet Gynaecol Res 2020; 47:359-367. [PMID: 33059391 DOI: 10.1111/jog.14533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/08/2020] [Accepted: 09/30/2020] [Indexed: 12/01/2022]
Abstract
AIM Analyze if the evaluation of aberrant right subclavian artery in the prenatal echography has improved the detection of chromosomal, genetic and/or morphological abnormalities in our population. METHODS Descriptive, observational, cross-sectional study of the cases of aberrant right subclavian artery diagnosed in our Prenatal Diagnosis Unit between January of 2011 and December of 2018. RESULTS Two hundred and fifty-seven cases of aberrant right subclavian artery were diagnosed and among them, 179 were considered isolated cases and thus were confirmed after birth. The detection of aberrant right subclavian artery did not improve itself neither the diagnosis of trisomy 21 in the second trimester of pregnancy nor other chromosomal or genetic abnormalities, including the not isolated cases. There were two cases of trisomy 21 diagnosed in the second trimester that presented major sonographic disorders and an inadequate examination during the first trimester. When aberrant right subclavian artery was associated with soft markers of aneuploidy in the second trimester, any case was a trisomy 21. Aberrant right subclavian artery seems to be associated with some minor and major heart defects, especially ventriculoseptal defect and aneurismatic ductus, and in some cases, also with clubfeet. CONCLUSION When an adequate screening of aneuploidies and a thorough ultrasound have been performed during the first trimester, aberrant right subclavian artery hardly helps to perform other diagnosis in the second trimester.
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Affiliation(s)
- Cristina Martínez-Payo
- Unidad de Diagnóstico Prenatal, Servicio de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Elena Suanzes
- Unidad de Diagnóstico Prenatal, Servicio de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Yolanda Nieto-Jiménez
- Unidad de Diagnóstico Prenatal, Servicio de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Miguel Ruiz de Azúa
- Unidad de Diagnóstico Prenatal, Servicio de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ana Siles
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ana Isabel Usano
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Tirso Pérez-Medina
- Jefe de Servicio, Servicio de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Kassif E, Tsur A, Shust-Barequet S, Raviv O, Kushnir A, Abu Snenh S, Achiron R, Mazaki-Tovi S, Weisz B, Salem Y, Weissbach T. The “No ARSA” Sign: A Novel Method of Prenatal Screening for Aberrant Right Subclavian Artery. J Clin Med 2020; 9:jcm9082658. [PMID: 32824459 PMCID: PMC7463697 DOI: 10.3390/jcm9082658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022] Open
Abstract
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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Affiliation(s)
- Eran Kassif
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Abraham Tsur
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Shir Shust-Barequet
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Oshrat Raviv
- Departments of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Anya Kushnir
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Samar Abu Snenh
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Reuven Achiron
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Shali Mazaki-Tovi
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Boaz Weisz
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
| | - Yishay Salem
- Pediatric Cardiology Unit, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: (Y.S.); (T.W.); Tel.: +972-546-250-299 (T.W.)
| | - Tal Weissbach
- Departments of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.K.); (A.T.); (S.S.-B.); (A.K.); (S.A.S.); (R.A.); (S.M.-T.); (B.W.)
- Correspondence: (Y.S.); (T.W.); Tel.: +972-546-250-299 (T.W.)
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Sagi-Dain L, Singer A, Josefsberg S, Peleg A, Lev D, Samra NN, Bar-Shira A, Zeligson S, Maya I, Ben-Shachar S. Microarray analysis has no additional value in fetal aberrant right subclavian artery: description of 268 pregnancies and systematic literature review. Ultrasound Obstet Gynecol 2019; 53:810-815. [PMID: 30584678 DOI: 10.1002/uog.20208] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 11/29/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
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. RESULTS Of 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, 0.8-37.6)). 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. CONCLUSION While 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. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L Sagi-Dain
- Genetics Institute, Carmel Medical Center, affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - A Singer
- Community Genetics, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - S Josefsberg
- Genetics Institute, Kaplan Medical Center, Rehovot, Israel
| | - A Peleg
- Genetics Institute, Carmel Medical Center, affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - D Lev
- The Rina Mor Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
| | - N Nasser Samra
- Institute of Human Genetics, Ziv Medical Center, Safed, Israel
| | - A Bar-Shira
- The Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Zeligson
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - I Maya
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - S Ben-Shachar
- The Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Masciello F, Fargion A, Innocenti AA, Giacomelli E, Voltolini L, Dorigo W, Pratesi C. Open surgical conversion for Type II endoleak following hybrid treatment of a giant aneurysm of aberrant right subclavian artery. J Surg Case Rep 2019; 2019:rjz058. [PMID: 30886695 PMCID: PMC6413370 DOI: 10.1093/jscr/rjz058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 01/31/2019] [Accepted: 02/12/2019] [Indexed: 12/02/2022] Open
Abstract
Type II endoleak following hybrid treatment of aneurysms of aberrant subclavian arteries (AARSA) and requiring reintervention is rare. A retroesophageal AARSA with a 70 mm diameter was treated with left and right carotid to subclavian bypasses and thoracic endografting to exclude its ostium. The distal neck was embolized with a vascular plug. At 22 months postoperatively, an angio-computed tomography (CT) scan performed for worsening of dysphagia showed the presence of a Type II endoleak from bronchial arteries with significant sac enlargement. An open surgical repair with thoracotomy, aneurysmorraphy and ligature of the feeding vessels was successfully performed.
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Affiliation(s)
- Fabrizio Masciello
- Department of Vascular Surgery, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Aaron Fargion
- Department of Vascular Surgery, University of Florence, Largo Brambilla 3, Florence, Italy
| | | | - Elena Giacomelli
- Department of Vascular Surgery, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Luca Voltolini
- Department of Thoracic Surgery, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Walter Dorigo
- Department of Vascular Surgery, University of Florence, Largo Brambilla 3, Florence, Italy
| | - Carlo Pratesi
- Department of Vascular Surgery, University of Florence, Largo Brambilla 3, Florence, Italy
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Abstract
An aneurysm of an aberrant subclavian artery is un usual prevalence of anomalies of aortic arch, with a literature reported prevalence of 2%. Timely elective intervention is of paramount. The advancement in stenting techniques has promoted this practice to be an alternative to conventional open surgical repair which is associated with high rates of perioperative complications including mortality outcomes. However, new faces of this old disease are emerging as we move to novelty and innovation era. We discuss in this review the advancements in this disease entity highlighting and collecting the world experiences.
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Affiliation(s)
- Saleem Jahangeer
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Mohamad Bashir
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Amer Harky
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK.,School of Medicine, Cardiff University, Cardiff, UK
| | - John Yap
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
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25
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Shah N. Prenatal Diagnosis of Aberrant Right Subclavian Artery in Unselected North Indian Population: Significance and Counselling. J Fetal Med 2018. [DOI: 10.1007/s40556-018-0168-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Beloosesky R, Shrim A, Steinberg M, Khatib N, Bronshtein M. Isolated aberrant right subclavian artery at 14-16 weeks of gestation and Down syndrome. J Clin Ultrasound 2018; 46:62-63. [PMID: 29080315 DOI: 10.1002/jcu.22543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/22/2017] [Accepted: 08/25/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Alon Shrim
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Maya Steinberg
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Moshe Bronshtein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
- Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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Svirsky R, Reches A, Brabbing-Goldstein D, Bar-Shira A, Yaron Y. Association of aberrant right subclavian artery with abnormal karyotype and microarray results. Prenat Diagn 2017; 37:808-811. [DOI: 10.1002/pd.5092] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/26/2017] [Accepted: 06/11/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Ran Svirsky
- Prenatal Genetic Diagnosis Unit & Genetic Institute; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Adi Reches
- Prenatal Genetic Diagnosis Unit & Genetic Institute; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Dana Brabbing-Goldstein
- Prenatal Genetic Diagnosis Unit & Genetic Institute; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Anat Bar-Shira
- Prenatal Genetic Diagnosis Unit & Genetic Institute; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit & Genetic Institute; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Gursoy Erzincan S, Karamustafaoglu Balci B, Tokgoz C, Kalelioglu IH. Incidence of an Aberrant Right Subclavian Artery on Second-Trimester Sonography in an Unselected Population. J Ultrasound Med 2017; 36:1015-1019. [PMID: 28258603 DOI: 10.7863/ultra.16.05075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to assess the incidence of an aberrant right subclavian artery (ARSA) among an unselected population during second-trimester sonography and to review the importance of this conotruncal variant as a marker of Down syndrome. METHODS The presence or absence of an ARSA was assessed in an unselected population of 1913 second-trimester fetuses. RESULTS Among the 1913 patients, an ARSA was detected in 20 fetuses (1.04%), all with a normal karyotype. Thirteen of 20 fetuses had an isolated ARSA, and 7 of them were nonisolated. Associated abnormal sonographic findings were an intracardiac echogenic focus (n = 3), a choroid plexus cyst (n = 1), pyelectasis (n = 1) and tetralogy of Fallot (n = 2). One of the cases of tetralogy of Fallot was also associated with a persistent left superior vena cava, a persistent right umbilical vein, hydrocephalus, rhombencephalosynapsis, and unilateral renal agenesis. There were only 2 fetuses with Down syndrome in this group, and both of them had a normal origin of the right subclavian artery. CONCLUSIONS In an unselected population, an ARSA may be seen less frequently than in a high-risk population and may not be related to Down syndrome. An isolated ARSA is not a sufficient indication for karyotype analysis; it can be managed with noninvasive prenatal testing rather than invasive testing.
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Affiliation(s)
- Selen Gursoy Erzincan
- Department of Obstetrics and Gynecology, Isparta Egirdir Bone Joint Disease and Rehabilitation Hospital, Isparta, Turkey
| | | | - Cengiz Tokgoz
- Department of Obstetrics and Gynecology, Bilge Hospital, Istanbul, Turkey
| | - Ibrahim Halil Kalelioglu
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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29
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Ranzini AC, Hyman F, Jamaer E, van Mieghem T. Aberrant Right Subclavian Artery: Correlation Between Fetal and Neonatal Abnormalities and Abnormal Genetic Screening or Testing. J Ultrasound Med 2017; 36:785-790. [PMID: 28072476 DOI: 10.7863/ultra.16.05028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To determine whether fetuses with an isolated aberrant course of the right subclavian artery (ARSA) have increased risk for chromosomal abnormalities, including trisomy 21 or 22q11 deletion. METHODS We performed a retrospective chart review of all fetuses with antenatally diagnosed ARSA. Data were collected from fetal anatomic surveys, fetal echocardiograms, noninvasive trisomy 21 screening programs, invasive genetic studies, and neonatal records. RESULTS Seventy-nine fetuses with ARSA were identified at 20.3 ± 3.8 weeks' gestation. Forty-eight fetuses underwent chromosomal evaluation. Of those, seven had trisomy 21. Four other fetuses had unusual karyotype abnormalities. All fetuses with genetic anomalies had additional aberrant ultrasound findings. There were three spontaneous fetal deaths (trisomy 21-2 and Wolf-Hirshhorn-1). Nine pregnancies were terminated because of abnormalities and one died as a result of hypoplastic left heart syndrome. No neonate was found or suspected to have 22q11.2 deletion. The ARSA was isolated in 43 fetuses; all had unremarkable neonatal outcomes, and none were readmitted within 6 months after discharge. CONCLUSIONS As an apparently isolated finding, ARSA is benign and not associated with trisomy 21 or 22q11.2 deletion. The finding of ARSA, however, warrants a detailed fetal ultrasound. All fetuses with ARSA and genetic anomalies had additional ultrasound findings.
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Affiliation(s)
- Angela C Ranzini
- Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey, USA
| | - Francine Hyman
- Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey, USA
| | - Emily Jamaer
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Tim van Mieghem
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
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30
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Maya I, Kahana S, Yeshaya J, Tenne T, Yacobson S, Agmon-Fishman I, Cohen-Vig L, Levi A, Reinstein E, Basel-Vanagaite L, Sharony R. Chromosomal microarray analysis in fetuses with aberrant right subclavian artery. Ultrasound Obstet Gynecol 2017; 49:337-341. [PMID: 27063194 DOI: 10.1002/uog.15935] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the association between aberrant right subclavian artery (ARSA), with or without additional risk factors for aneuploidy or ultrasound abnormality, and results of chromosomal microarray analysis (CMA). METHODS This was a multicenter study of fetuses diagnosed with ARSA that underwent genetic analysis by CMA, all samples being analyzed in the same laboratory. Clinical investigation included nuchal translucency measurement, first- and second-trimester maternal serum screening, early and late second-trimester fetal anatomy scans and fetal echocardiography. Comparative genomic hybridization microarray analysis or single-nucleotide polymorphism array technology was used for CMA of DNA samples obtained from amniotic fluid. RESULTS CMA results were available for 63 fetuses with ARSA. In 36 fetuses, ARSA was an isolated finding, and no pathogenic variant was found. Additional ultrasound findings and/or risk factors for aneuploidy were present in 27 fetuses, five of which had pathogenic CMA results. Of these five, trisomy 21 was detected in a fetus with echogenic intracardiac focus (EIF), 22q11 deletion was detected in a fetus with EIF and an increased risk of trisomy 21 of 1:230 from maternal serum screening, 22q11 duplication was detected in a fetus with hypoplastic right kidney and choroid plexus cyst and 22q11 deletion was detected in a fetus with right aortic arch and clubfoot. The fifth fetus had increased nuchal translucency thickness (4 mm) and a ventricular septal defect, and CMA identified both 22q11 deletion and 1q21 duplication. CONCLUSIONS In fetuses with isolated ARSA, an invasive procedure for CMA is not indicated. However, CMA is recommended when additional ultrasound abnormalities or risk factors for aneuploidy are observed. The chromosomal findings in four of the five cases with an abnormal CMA result in our study would not have been detected by standard fetal chromosomal testing. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- I Maya
- The Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Kahana
- The Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - J Yeshaya
- The Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - T Tenne
- The Genetics Institute, Meir Medical Center, Kfar Saba, Israel
| | - S Yacobson
- The Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - I Agmon-Fishman
- The Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - L Cohen-Vig
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - A Levi
- Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
| | - E Reinstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Genetics Institute, Meir Medical Center, Kfar Saba, Israel
| | - L Basel-Vanagaite
- The Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Genetics Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva, Israel
| | - R Sharony
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Genetics Institute, Meir Medical Center, Kfar Saba, Israel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
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Song MJ, Han BH, Kim YH, Yoon SY, Lee YM, Jeon HS, Park BK. Prenatal diagnosis of aberrant right subclavian artery in an unselected population. Ultrasonography 2017; 36:278-283. [PMID: 28322033 PMCID: PMC5494869 DOI: 10.14366/usg.16046] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 11/22/2022] Open
Abstract
Purpose The purpose of this study was to determine the frequency of aberrant right subclavian artery (ARSA) among unselected fetuses and to evaluate its association with chromosomal abnormalities and other congenital anomalies. Methods In all, 7,547 fetuses (gestational age, 20 to 34 weeks) were examined using routine antenatal sonography at our institution between April 2014 and September 2015. The right subclavian artery was assessed using grayscale and color Doppler ultrasonography in the transverse 3-vessel and tracheal view, and confirmed in the coronal plane. Results ARSA was found in 28 fetuses (0.4%). Further, 27 of these 28 fetuses were euploid (96.4%). Trisomy 18 was the only chromosomal anomaly (3.6%) found in the study sample. ARSA was an isolated finding in 23 of the 28 cases (82.1%). In the remaining three cases (10.7%), ARSA was accompanied with extracardiac anomalies. Other cardiac defects were present in three cases (10.7%). Conclusion Isolated ARSA does not seem to be associated with a significantly increased risk of aneuploidy. However, the possibility of fetal karyotyping, which is a more invasive procedure, should be discussed in the light of the overall risk of the fetus.
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Affiliation(s)
- Mi Jin Song
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Byoung Hee Han
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Young-Hwa Kim
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - So Young Yoon
- Department of Pediatrics, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Yoo Mi Lee
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Hye Su Jeon
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Bo Kyung Park
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
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Vikraman SK, Chandra V, Balakrishnan B, Batra M, Sreeja PS, Patil SN, Kannoly G. Significance of Fetal Aberrant Right Subclavian Artery and Comparison with Other Second Trimester Markers for Down Syndrome Screening. J Fetal Med 2016; 3:159-65. [DOI: 10.1007/s40556-016-0104-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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García-guereta L, García-cerro E, Bret-zurita M. Tomografía computarizada con multidetectores en las anomalías congénitas del arco aórtico: anillos vasculares. Rev Esp Cardiol 2016; 69:681-93. [DOI: 10.1016/j.recesp.2016.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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García-Guereta L, García-Cerro E, Bret-Zurita M. Multidetector Computed Tomography for Congenital Anomalies of the Aortic Arch: Vascular Rings. ACTA ACUST UNITED AC 2016; 69:681-93. [PMID: 27311384 DOI: 10.1016/j.rec.2016.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/31/2016] [Indexed: 11/25/2022]
Abstract
The development of multidetector computed tomography has triggered a revolution in the study of the aorta and other large vessels and has replaced angiography in the diagnosis of congenital anomalies of the aortic arch, particularly vascular rings. The major advantage of multidetector computed tomography is that it permits clear 3-dimensional assessment of not only vascular structures, but also airway and esophageal compression. The current update aims to summarize the embryonic development of the aortic arch and the developmental anomalies leading to vascular ring formation and to discuss the current diagnostic and therapeutic role of multidetector computed tomography in this field.
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Affiliation(s)
- Luis García-Guereta
- Servicio de Cardiología Pediátrica, Hospital Universitario La Paz, Madrid, Spain.
| | | | - Montserrat Bret-Zurita
- Servicio de Radiodiagnóstico, Radiología Pediátrica, Imagen Cardiaca Pediátrica y Cardiopatías Congénitas, Hospital Universitario La Paz, Madrid, Spain
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Bravo C, Gámez F, Pérez R, Álvarez T, De León-Luis J. Fetal Aortic Arch Anomalies: Key Sonographic Views for Their Differential Diagnosis and Clinical Implications Using the Cardiovascular System Sonographic Evaluation Protocol. J Ultrasound Med 2016; 35:237-251. [PMID: 26715656 DOI: 10.7863/ultra.15.02063] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/23/2015] [Indexed: 06/05/2023]
Abstract
Aortic arch anomalies are present in 1% to 2% of the general population and are commonly associated with congenital heart disease, chromosomal defects, and tracheaesophageal compression in postnatal life. The sonographically based detection of aortic arch anomalies lies in the 3-vessel and trachea view. Although highly sensitive, this view alone does not allow identification of the aortic arch branching pattern, which prevents an accurate diagnosis. The systematic addition of a subclavian artery view as part of a standardized procedure may be useful in the differential diagnosis of these conditions. We describe the sonographic assessment of fetal aortic arch anomalies by combining 2 fetal transverse views: the 3-vessel and trachea view and the subclavian artery view, which are included in the cardiovascular system sonographic evaluation protocol. We also review the sonographic findings and the clinical implications of fetal aortic arch anomalies.
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Affiliation(s)
- Coral Bravo
- Departments of Obstetrics and Gynecology (C.B.A., F.G., R.P., J.D.L.-L.) and Pediatric Cardiology (T.Á.), Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.A.)
| | - Francisco Gámez
- Departments of Obstetrics and Gynecology (C.B.A., F.G., R.P., J.D.L.-L.) and Pediatric Cardiology (T.Á.), Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.A.)
| | - Ricardo Pérez
- Departments of Obstetrics and Gynecology (C.B.A., F.G., R.P., J.D.L.-L.) and Pediatric Cardiology (T.Á.), Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.A.)
| | - Teresa Álvarez
- Departments of Obstetrics and Gynecology (C.B.A., F.G., R.P., J.D.L.-L.) and Pediatric Cardiology (T.Á.), Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.A.)
| | - Juan De León-Luis
- Departments of Obstetrics and Gynecology (C.B.A., F.G., R.P., J.D.L.-L.) and Pediatric Cardiology (T.Á.), Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.A.).
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Pico H, Mancini J, Lafouge A, Bault JP, Gorincour G, Quarello E. Prenatal Associated Features in Fetuses Diagnosed with an Aberrant Right Subclavian Artery. Fetal Diagn Ther 2016; 40:187-194. [DOI: 10.1159/000443524] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/30/2015] [Indexed: 11/19/2022]
Abstract
Objective: The objective of this study was to determine the frequency and the nature of associated anomalies, especially malformations and chromosome abnormalities, in a population of fetuses with an aberrant right subclavian artery (ARSA). Materials and Methods: This is a 7-year descriptive study. All patients whose fetus had an ARSA diagnosed by ultrasound performed during the 1st, 2nd, or 3rd trimester of pregnancy were included, regardless of their risk of chromosomal abnormalities. Results: Between May 2007 and April 2014, an ARSA was diagnosed in 120 fetuses. The outcome was found in 108 cases (90%). ARSA was an isolated finding in 54/108 cases (50%). In 20% (22/108) of the fetuses, chromosomal abnormalities were detected. No chromosomal abnormalities were found in fetuses with an isolated ARSA. 82% (18/22) of chromosomal abnormalities were usual, such as trisomies 21 and 18, monosomy X, and 22q11.2 deletion. 21% (23/108) of the fetuses presenting an ARSA were associated with having a congenital heart disease. Conclusion: The presence of an isolated ARSA is a condition rarely associated with a chromosomal abnormality. The decision to perform an invasive karyotyping procedure under such circumstances or not may be made according to the principle of parental autonomy after extensive counselling and mostly a thorough assessment of the fetus.
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Yao Y, Liao Y, Han M, Li SL, Luo J, Zhang B. Two kinds of common prenatal screening tests for Down's syndrome: a systematic review and meta-analysis. Sci Rep 2016; 6:18866. [PMID: 26732706 PMCID: PMC4702166 DOI: 10.1038/srep18866] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 11/11/2015] [Indexed: 12/18/2022] Open
Abstract
As the chromosomal examination of foetal cells for the prenatal diagnosis of Down's syndrome (DS) carries a risk of inducing miscarriage, serum screening tests are commonly used before invasive procedures. In this study, a total of 374 records from PubMed, EMBASE, and the ISI Science Citation Index databases were reviewed. As a result of duplication, insufficient data, and inappropriate article types, 18 independent articles containing 183,998 samples were used in the final systematic review and meta-analysis of the diagnostic performance of the serum triple screening test (STS) and the integrated screening test (INS). Data extracted from the selected studies were statistically analysed, and the presence of heterogeneity and publication bias was assessed using specific software. The overall sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the area under the curve for the STS were 0.77 (95% confidence interval = 0.73-0.81), 0.94 (0.94-0.94), 9.78 (6.87-13.93), 0.26 (0.22-0.31), 44.72 (30.77-65.01), and 0.9064, respectively. For the INS, these values were 0.93 (0.90-0.95), 0.93 (0.93-0.93), 22.38 (12.47-40.14), 0.08 (0.05-0.11), 289.81 (169.08-496.76), and 0.9781, respectively. These results indicate that the INS exhibits better diagnostic value for DS. However, further research is needed to identify other biomarkers to improve prenatal screening tests.
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Affiliation(s)
- Yuan Yao
- Department of Laboratory Medicine, Southwest Hospital, Third Military Medical University of PLA, Chongqing 400038, PR China
- Department of Laboratory Medicine, No. 191 Clinical Department of No. 303 Hospital of PLA, Guigang 537100, Guangxi, PR China
| | - Yang Liao
- Department of Laboratory Medicine, Guangzhou General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, Guangdong, PR China
| | - Mei Han
- Department of Laboratory Medicine, Southwest Hospital, Third Military Medical University of PLA, Chongqing 400038, PR China
| | - Sheng-Lan Li
- Department of Laboratory Medicine, Southwest Hospital, Third Military Medical University of PLA, Chongqing 400038, PR China
| | - Juan Luo
- Department of Laboratory Medicine, Southwest Hospital, Third Military Medical University of PLA, Chongqing 400038, PR China
| | - Bo Zhang
- Department of Laboratory Medicine, Southwest Hospital, Third Military Medical University of PLA, Chongqing 400038, PR China
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Scala C, Leone Roberti Maggiore U, Candiani M, Venturini PL, Ferrero S, Greco T, Cavoretto P. Aberrant right subclavian artery in fetuses with Down syndrome: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2015; 46:266-276. [PMID: 25586729 DOI: 10.1002/uog.14774] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 11/09/2014] [Accepted: 12/23/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The primary objective was to estimate the prevalence of aberrant right subclavian artery (ARSA) in fetuses with Down syndrome. Secondary objectives were to assess the prevalence of ARSA in euploid fetuses, the feasibility of ultrasound evaluation of the right subclavian artery (RSA) in the first and second trimesters of pregnancy, the performance of ARSA in screening for trisomy 21 and its association with other abnormalities. METHODS Web-based databases (PubMed, EMBASE and MEDLINE) were searched up to July 2014. The STROBE, PRISMA and QUIPS instruments were used to assess all included studies and for reporting of methodology, results and conclusions. Original studies that reported prenatal ultrasound evaluation of ARSA, assessment of its prevalence in Down-syndrome and euploid fetuses, feasibility of ultrasound evaluation of the RSA in the first and second trimesters of pregnancy and correlation of ARSA with other abnormalities were included, excluding duplications and case reports. Collected data were summarized to estimate prevalence and feasibility. A meta-analysis was performed pooling the study-specific positive and negative likelihood ratios (LR+ and LR-), detection rates and false-positive rates for trisomy 21. RESULTS Prevalence of ARSA in Down-syndrome fetuses was 23.6% (95% CI, 19.4-27.9%), whereas in euploid fetuses it was 1.02% (95% CI, 0.86-1.10%). Ultrasound evaluation of the RSA course and origin in the first and second trimesters of pregnancy was feasible in 85% and 98% of cases (first and second trimester, respectively) and it was directly related to sonographic experience and fetal crown-rump length and inversely related to maternal body mass index. In more than 20% of fetuses with ARSA there was an association with other abnormalities but ARSA seemed to be an independent marker of trisomy 21. The meta-analysis showed that ARSA is a significant risk factor for Down syndrome (pooled LR+ = 26.93, 95% CI, 19.36-37.47, P for effect < 0.001, P for Q = 0.3, I(2) = 17.3%), whereas normal RSA is a significant protective marker (pooled LR- = 0.71, 95% CI, 0.51-0.99, P for effect = 0.043, P for Q = 0.9, I(2) = 0%). CONCLUSIONS ARSA appears to be a clinically useful prenatal ultrasound marker of Down syndrome. Additional testing when ARSA is diagnosed should involve evaluation of all risk factors by applying a mathematical model. There is insufficient evidence to recommend fetal karyotyping in cases with isolated ARSA. If the background risk is higher or additional markers are present, full fetal karyotyping is advisable, including analysis for 22q11 microdeletion.
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Affiliation(s)
- C Scala
- Department of Obstetrics and Gynecology, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Genoa, Italy
| | - U Leone Roberti Maggiore
- Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - M Candiani
- Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - P L Venturini
- Department of Obstetrics and Gynecology, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Genoa, Italy
| | - S Ferrero
- Department of Obstetrics and Gynecology, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Genoa, Italy
| | - T Greco
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - P Cavoretto
- Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
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Flowers N, Kelley J, Sigurjonsson S, Bruno DL, Pertile MD. Maternal mosaicism for a large segmental duplication of 18q as a secondary finding following non-invasive prenatal testing and implications for test accuracy. Prenat Diagn 2015; 35:986-9. [DOI: 10.1002/pd.4636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/31/2015] [Accepted: 06/11/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Nicola Flowers
- Victorian Clinical Genetics Services Cytogenetics Laboratory; Murdoch Childrens Research Institute; Melbourne Australia
| | - Joanne Kelley
- Genetics Clinic; Mercy Hospital for Women; Melbourne Australia
| | | | - Damien L. Bruno
- Victorian Clinical Genetics Services Cytogenetics Laboratory; Murdoch Childrens Research Institute; Melbourne Australia
| | - Mark D. Pertile
- Victorian Clinical Genetics Services Cytogenetics Laboratory; Murdoch Childrens Research Institute; Melbourne Australia
- Department of Paediatrics; University of Melbourne; Melbourne Australia
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De León-Luis J, Bravo C, Gámez F, Ortiz-Quintana L. Cardiovascular System Sonographic Evaluation Algorithm: A New Sonographic Algorithm for Evaluation of the Fetal Cardiovascular System in the Second Trimester. J Ultrasound Med 2015; 34:1271-1282. [PMID: 26112631 DOI: 10.7863/ultra.34.7.1271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate the reproducibility and feasibility of the new cardiovascular system sonographic evaluation algorithm for studying the extended fetal cardiovascular system, including the portal, thymic, and supra-aortic areas, in the second trimester of pregnancy (19-22 weeks). METHODS We performed a cross-sectional study of pregnant women with healthy fetuses (singleton and twin pregnancies) attending our center from March to August 2011. The extended fetal cardiovascular system was evaluated by following the new algorithm, a sequential acquisition of axial views comprising the following (caudal to cranial): I, portal sinus; II, ductus venosus; III, hepatic veins; IV, 4-chamber view; V, left ventricular outflow tract; VI, right ventricular outflow tract; VII, 3-vessel and trachea view; VIII, thy-box; and IX, subclavian arteries. Interobserver agreement on the feasibility and exploration time was estimated in a subgroup of patients. The feasibility and exploration time were determined for the main cohort. Maternal, fetal, and sonographic factors affecting both features were evaluated. RESULTS Interobserver agreement was excellent for all views except view VIII; the difference in the mean exploration time between observers was 1.5 minutes (95% confidence interval, 0.7-2.1 minutes; P < .05). In 184 fetuses (mean gestational age ± SD, 20 ± 0.6 weeks), the feasibility of all views was close to 99% except view VIII (88.7%). The complete feasibility of the algorithm was 81.5%. The mean exploration time was 5.6 ± 4.2 minutes. Only the occiput anterior fetal position was associated with a lower frequency of visualization and a longer exploration time (P < .05). CONCLUSIONS The cardiovascular system sonographic evaluation algorithm is a reproducible and feasible approach for exploration of the extended fetal cardiovascular system in a second-trimester scan. It can be used to explore these areas in normal and abnormal conditions and provides an integrated image of extended fetal cardiovascular anatomy.
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Affiliation(s)
- Juan De León-Luis
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain (C.B., F.G., L.O.Q., J.D.L.-L.); and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.).
| | - Coral Bravo
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain (C.B., F.G., L.O.Q., J.D.L.-L.); and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.)
| | - Francisco Gámez
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain (C.B., F.G., L.O.Q., J.D.L.-L.); and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.)
| | - Luis Ortiz-Quintana
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain (C.B., F.G., L.O.Q., J.D.L.-L.); and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.)
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