Case report and literature review: fetal diagnosis of vascular ring with circumflex right aortic arch and unique aortic arch branching pattern.

IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Frontiers in Cardiovascular Medicine Pub Date : 2025-03-10 eCollection Date: 2025-01-01 DOI:10.3389/fcvm.2025.1523356
Tyler Langenfeld, Yumna Ali, Chetan Sharma, Arpit Agarwal
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引用次数: 0

Abstract

Circumflex right aortic arch is a rare aortic arch anomaly where the arch extends in a retro-esophageal pattern with a left-sided descending thoracic aorta. In the setting of circumflex right aortic arch with the ductus arteriosus connecting the left descending aorta and left pulmonary artery, a vascular ring is present and can cause compressive symptoms of the aerodigestive tract. A 33-year-old G4P3 patient underwent fetal echocardiography after obstetric ultrasound showed concern for double aortic arch. Fetal echocardiogram was suspicious for vascular ring with presumptive diagnosis of double aortic arch vs. circumflex right aortic arch. The child was born at 38 weeks gestation via induced vaginal delivery and had an uneventful postnatal course. Post-natal echocardiogram was able to diagnose vascular ring but could not fully assess the arch or branching pattern. Cardiac computed tomography angiography (CCTA) was able to definitively diagnose right aortic arch and characterize the branching pattern. To our knowledge, this is the first case reported in the literature of a circumflex right aortic arch suspected on fetal echocardiogram and postnatal echocardiogram and subsequently confirmed with CCTA. Fetal echocardiogram provides a unique opportunity to assess the aortic arch as the trachea is filled with fluid. However, circumflex aortic arch and double aortic arch can be difficult to delineate on fetal or post-natal echocardiography. CCTA is an effective modality for evaluation of the aortic arch and its branching pattern in the setting of non-diagnostic echocardiography.

胎儿诊断血管环伴右主动脉弓弯曲及独特的主动脉弓分支形态。
右主动脉弓弯曲是一种罕见的主动脉弓异常,其弓在左侧胸降主动脉的食道后模式下延伸。在右主动脉弓弯曲处,动脉导管连接左降主动脉和左肺动脉,可见血管环,可引起空气消化道压缩症状。一名33岁的G4P3患者在产科超声检查后接受胎儿超声心动图检查,发现双主动脉弓。胎儿超声心动图可疑血管环,推测诊断为双主动脉弓或右主动脉弓弯曲。这个孩子在妊娠38周时通过阴道引产出生,并有一个平静的产后过程。产后超声心动图能够诊断血管环,但不能完全评估弓或分支模式。心脏计算机断层血管造影(CCTA)能够明确诊断右主动脉弓和表征分支模式。据我们所知,这是文献中第一例在胎儿超声心动图和出生后超声心动图上怀疑右主动脉弓弯曲并随后用CCTA确诊的病例。胎儿超声心动图提供了一个独特的机会来评估主动脉弓,因为气管充满了液体。然而,旋主动脉弓和双主动脉弓可能难以划定胎儿或产后超声心动图。在非诊断性超声心动图的情况下,CCTA是评估主动脉弓及其分支形态的有效方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Frontiers in Cardiovascular Medicine
Frontiers in Cardiovascular Medicine Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.80
自引率
11.10%
发文量
3529
审稿时长
14 weeks
期刊介绍: Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers? At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.
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