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Postnatal impact of a prenatally diagnosed double aortic arch
  1. Trisha V Vigneswaran1,2,3,
  2. Milou PM Van Poppel3,
  3. Benedict Griffiths4,
  4. Paul James4,
  5. Haran Jogeesvaran5,
  6. Zehan Rahim6,
  7. John M Simpson1,2,3,
  8. Simone Speggiorin1,
  9. Vita Zidere1,2,
  10. Andrew Nyman4
  1. 1Department of Congenital Heart Disease, Evelina London Children’s Hospital, London, UK
  2. 2Harris Birthright Centre for Fetal Medicine, King’s College Hospital NHS Foundation Trust, London, UK
  3. 3Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
  4. 4Paediatric Intensive Care Unit, Evelina London Children’s Hospital, London, UK
  5. 5Department of Radiology, Evelina London Children's Hospital, London, UK
  6. 6Paediatric Respiratory Medicine, Evelina London Children’s Hospital, London, UK
  1. Correspondence to Dr Trisha V Vigneswaran, Department of Congenital Heart Disease, Evelina London Children's Hospital, London SE1 7EH, London, UK; Trisha.Vigneswaran{at}gstt.nhs.uk

Abstract

Background A double aortic arch (DAA) is increasingly identified before birth; however, there are no published data describing the postnatal outcome of a large prenatal cohort.

Objective To describe the associations, symptoms and impact of prenatally diagnosed DAA.

Methods Retrospective review of consecutive cases seen at two fetal cardiology units from 2014 to 2019. Clinical records including symptoms and assessment of tracheobronchial compression using flexible bronchoscopy were reviewed. Moderate–severe tracheal compression was defined as >75% occlusion of the lumen.

Results There were 50 cases identified prenatally and 48 with postnatal follow-up. Array comparative genomic hybridisation (aCGH) was abnormal in 2/50 (4%), aCGH was normal in 33/50 (66%) and of those reviewed after birth, 13 were phenotypically normal. After birth, there was a complete DAA with patency of both arches in 8/48 (17%) and in 40/48 (83%) there was a segment of the left arch which was a non-patent, ligamentous connection.

Stridor was present in 6/48 (13%) on the day of birth. Tracheo-oesophageal compressive symptoms/signs were present in 31/48 (65%) patients at median age of 59 days (IQR 9–182 days). Tracheal/carinal compression was present in 40/45 (88%) cases. Seven of 17 (41%) asymptomatic cases demonstrated moderate–severe tracheal compression. All morphologies of DAA caused symptoms and morphology type was not predictive of significant tracheal compression (p=0.3).

Conclusions Genetic testing should be offered following detection of double aortic arch. Early signs of tracheal compression are common and therefore delivery where onsite neonatal support is available is recommended. Significant tracheal compression may be present even in the absence of symptoms.

  • cardiac surgery
  • cardiology
  • congenital abnorm
  • fetal medicine
  • respiratory

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Footnotes

  • Collaborators Ms (Dr) Victoria Possamai Victoria.Possamai@gstt.nhs.uk Department of Paediatric ENT Surgery.

  • Contributors The study design was conceived by TVV. Data acquisition and interpretation by all authors. Data collated, analysed and reviewed by MVP, TVV, HJ and AN.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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