Simon Meagher: Prenatal Ultrasound Case Explores Suspected Double Aortic Arch
Simon Meagher, Medical Director at Monash Ultrasound For Women, shared a post on LinkedIn:
“A 34-year-old patient was referred at 25 weeks’ gestation with suspected double aortic arch. Please review the video and consider the questions below:
Labels: Ao= Aorta; DAo= Descending Aorta, MPA = Main pulmonary artery; RPA = Right pulmonary artery; SVC= Superior vena cava; T = trachea.
Caution No1 : 1) A RPA juxtaposed to the Aortic Arch, or 2) Prominent neck vessels imaged obliquely, may mimic a double aortic arch.
1. Is the Ao arch right-sided?
2. Where is Ao relative to Trachea?
3. Is the ductus LT or RT-sided?
4. Is there a vascular ring?
5. Is the 3VT view diagnostic?
6. Is the 4-chamber view normal?
7. Are other cardiac anomalies present?
8. What affects prognosis?
9. Could the RPA mimic a double arch?
10. Could a high plane mistake neck vessels for a double arch?
Key facts: A right aortic arch passes to the right of the trachea. Define the ductal side and branching pattern, look for an aberrant left subclavian artery and Kommerell diverticulum, and determine whether a complete vascular ring is present. Exclude associated conotruncal defects and consider genetic investigation, particularly for 22q11.2 deletion. Isolated cases usually have a good prognosis, although symptomatic vascular rings may cause postnatal airway or swallowing difficulties. Caution: An RPA juxtaposed to the Aorta, or neck vessels imaged obliquely, may mimic a double aortic arch.
Caution No 2 : Colour Doppler may falsely suggest a perimembranous VSD and should always be interpreted alongside 2D imaging.
Concise Prenatal Report:
‘At 25 weeks’ gestation, fetal echocardiography demonstrates a right aortic arch with a left-sided ductus arteriosus. No aberrant left subclavian artery is identified, reducing the likelihood of a complete vascular ring. No additional intracardiac or extracardiac abnormality is seen, and cardiac rhythm and function are normal. The association with chromosomal abnormalities, particularly 22q11.2 deletion, was discussed, and genetic counselling with consideration of amniocentesis and chromosomal microarray is recommended. Follow-up fetal echocardiography and postnatal cardiac assessment are advised’.
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Proceed to the video attached to the post.
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