Key result
First trimester ultrasound detected fetal right aortic arch with an incidence of 0.11% in low-risk pregnancies, with 50% of cases associated with other congenital heart abnormalities.
Why the study?
Although right aortic arch is mostly isolated and asymptomatic, it can be associated with other fetal structural abnormalities that require prenatal detection and monitoring.
Observational (n=14)
No
First-trimester ultrasound can detect right aortic arch, which has an incidence of 0.11% in low-risk pregnancies and is associated with other congenital heart abnormalities in 50% of cases.
Warrants caution before routine first-trimester screening; hypothesis-generating for right aortic arch as marker of other defects.
OBJECTIVES: In the present research we proposed to evaluate the cases diagnosed in the first trimester of pregnancy by ultrasound with RAA, knowing the fact that although, in most cases the disease is isolated and asymptomatic, in some cases the presence of RAA can be associated with other fetal structural abnormalities that must be detected and monitored during pregnancy. We established correlations between the postnatal or anatomopathological examination (in cases ended by therapeutic abortion) and the presence of RAA detected in the first trimester. MATERIAL AND METHOD: We conducted a retrospective analytical study that investigated the role of the RAA early detection (isolated or associated with other cardiac abnormalities) for a correct pregnancy monitoring and postpartum management. Between 2012 and 2018, patients admitted in the first Obstetrics and Gynecology Clinic-the Prenatal Diagnostic Unit-of the Emergency County Hospital from Craiova, were evaluated in the first trimester of pregnancy for genetic abnormalities and early morphology. The study material was represented by the patient's medical records (observation sheets, surgical protocol records, anatomopathological diagnostic records). The obtained information was stored in Microsoft Excel files and statistically processed. RESULTS: During the study period, 14 cases with right aortic arch were diagnosed in the first and second trimester of pregnancy. 4 cases were detected in the first trimester: 2 cases (50%) presented left ductus arteriosus (DA)-RAA type 2 ("U" sign) and 2 cases (50%) presented right DA-RAA type 1 (mirror image-"V" sign). RAA type 1 associated Tetralogy of Fallot in one case (25%) and in another one case (25%) the anomaly was isolated. RAA type 2 associated atrio-ventricular septal defect (AVSD) in one case (25%) and in another one case (25%) the anomaly was isolated. There were no fetal extracardiac structural abnormalities associated with the RAA diagnosis in the first trimester. CONCLUSIONS: Over a seven years study period (2012-2018), 14 cases with RAA in the first and second trimester of pregnancy were detected. In the low-risk pregnancies group, the first trimester incidence of the RAA was 0.11% and the association of congenital heart abnormalities was 50%.
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Patru et al. (2019) conducted an observational in Fetal Right Aortic Arch (RAA) (n=14). First trimester ultrasound diagnosis of RAA was evaluated on Incidence of RAA and association with congenital heart abnormalities. First trimester ultrasound detected fetal right aortic arch with an incidence of 0.11% in low-risk pregnancies, with 50% of cases associated with other congenital heart abnormalities.
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