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Fetal interrupted aortic arch: 2D-4D echocardiography, associations and outcome
- Source :
- Ultrasound in Obstetrics and Gynecology. 35:302-309
- Publication Year :
- 2010
- Publisher :
- Wiley, 2010.
-
Abstract
- Objectives To analyze fetal two-dimensional (2D) echocardiographic characteristics of interrupted aortic arch (IAA) and its different types, to explore whether the use of 4D ultrasound with B-flow imaging and spatiotemporal image correlation (STIC) can improve prenatal diagnostic accuracy, and to describe associations and outcome. Methods The study comprised IAA fetuses examined exclusively by 2D conventional echocardiography during the period from 1994 to 2003, and those identified by conventional echocardiography and examined further by 4D ultrasound with B-flow imaging and STIC during the period January 2004 to July 2008, identified among fetuses examined at two referral centers for congenital heart defects (CHD). Postnatal follow-up was available in all cases. Karyotyping and fluorescent in-situ hybridization (FISH) analysis for the DiGeorge critical region (22q11.2) were performed in all cases. Results Twenty-two cases of isolated IAA (15 Type B and seven Type A, seven and three of which, respectively, underwent B-flow imaging and STIC) were detected among 2520 cases of fetal CHD. In seven of the 15 Type B cases, a right subclavian artery arose anomalously (ARSA). 2D echocardiography failed to distinguish the type of IAA in only two cases and the ARSA in five of the seven cases. B-flow imaging and STIC successfully identified IAA types in all 10 cases examined and clearly visualized the origin and course of the ARSA, including cervical ones. FISH detected 22q11.2 microdeletion in 10 of the 15 Type B cases and an unusual association with Type A in one of the seven cases. Fetal/neonatal outcome included: eight terminations of pregnancy, one intrauterine death and four postoperative deaths in the neonatal period, and nine neonates were alive after surgery at a mean follow-up time of 58 months (range, 4 months‐13 years). Conclusion Our results confirm the feasibility of prenatal characterization of IAA and its different types based on 2D echocardiographic examination, albeit with some limitations in the thorough assessment. 4D ultrasound with B-flow imaging and STIC can apparently facilitate visualization and detailed examination of the anatomical features of the IAA types, including visualization of the neck vessels, thus supplying additional information with respect to 2D sonography. As for the known association with microdeletion 22q11.2, our data indicate that Types A and B are distinct, there being a close association only with IAA Type B. Copyright 2009 ISUOG. Published by John Wiley & Sons, Ltd.
- Subjects :
- Heart Defects, Congenital
Aortic arch
medicine.medical_specialty
Aorta, Thoracic
Gestational Age
Prenatal diagnosis
Ultrasonography, Prenatal
Fetal Heart
Pregnancy
medicine.artery
medicine
Humans
Radiology, Nuclear Medicine and imaging
Echocardiography, Four-Dimensional
Aorta
Fetus
Radiological and Ultrasound Technology
medicine.diagnostic_test
business.industry
Interrupted aortic arch
Infant, Newborn
Pregnancy Outcome
Obstetrics and Gynecology
Gestational age
General Medicine
medicine.disease
Surgery
Reproductive Medicine
Echocardiography
Karyotyping
Female
Radiology
business
Fetal echocardiography
Subjects
Details
- ISSN :
- 14690705 and 09607692
- Volume :
- 35
- Database :
- OpenAIRE
- Journal :
- Ultrasound in Obstetrics and Gynecology
- Accession number :
- edsair.doi.dedup.....f15619bc2e71f2502cf58239e1be72bc