Hu Yuan,Liu Qianjun,Xiao Limiao,et al.Clinical features and ultrasonic diagnosis of congenital double aortic arch in infants and toddlers[J].Journal of Clinical Pediatric Surgery,,19():842-846.[doi:10.3969/j.issn.1671-6353.2020.09.016]
Clinical features and ultrasonic diagnosis of congenital double aortic arch in infants and toddlers
- Keywords:
- Aorta; Thoracic/AB; Aorta; Thoracic/PP; Aorta; Thoracic/US
- CLC:
- R729;R445.1
- Abstract:
- Objective To summarize the clinical features and ultrasonic imaging characteristics of congenital double aortic arch (DAA) in infants and toddlers and explore the diagnostic techniques of improving the diagnostic rate of DAA by ultrasound. Methods The clinical data and ultrasonic imaging characteristics were retrospectively analyzed for 14 DAA infants and toddlers from January 2015 to December 2019.There were 8 boys and 6 girls with a median age of 7 months (1 day to 2 years) and a median body weight of 7(3.2-12.5) kg.After conventional cardiac section,special attention was paid to exploring the long axis and short axis of aortic arch of upper sternal fossa,continuous sections and position,number,shape,inner diameter,branch shape and structure of aortic arch.A definite diagnosis was made by plain/enhanced CT scan or surgery. Results The diagnosis was made by ultrasound (n=13) or missed (n=1).The diagnostic coincidence rate between ultrasound and CT was 92.8%.And the clinical types were right arch dominant (9/14,64.2%),left arch dominant (3/14,21.4%) and double bow balance type (2/14,14.2%).The etiologies were isolated DAA (n=9),ventricular septal defect (n=2),tetralogy of Fallot (TOF,n=1) and atrial septum defect (n=2).Twelve children were operated while two cases were followed up. Conclusion DAA may cause severe respiratory symptoms in infants and toddlers.Continuous ultrasonic scans of long/short axes of aortic arch of upper sternal fossa should be performed along CT examination to boost the diagnosis rate of DAA and improve the prognosis by making an early diagnosis and offering proper treatments.
References:
1 马宁,金兰中.实用小儿心血管超声诊断[M].北京:科学技术文献出版社,2019:164-174.Ma N,Jin LZ.Practical ultrasonic diagnoses of cardiovascular diseases in children[M].Beijing:Scientific and Technical Documentation Press,2019:164-174.
2 周丹,陶凉,陈绪发,等.双主动脉弓合并复杂心内畸形的外科诊治[J].中华胸心血管外科杂志,2017,33(6):326-329.DOI:10.3760/cma.j.issn.1001-4497.2017.06.002.Zhou D,Tao L,Chen XF,et al.Surgical managements of double aortic arch associated with complex intra-cardiac anomalies[J].Chin J Thorac Cardiovasc Surg,2017,33(6):326-329.DOI:10.3760/cma.j.issn.1001-4497.2017.06.002.
3 Yang Y,Jin X,Pan Z,et al.Diagnosis and surgical repair of congenital double aortic arch in infants[J].J Cardiothorac Surg,2019,14(1):160.DOI:10.1186/s13019-019-0976-x.
4 Backer CL,Mavroudis C.Congenital Heart Surgery Nomenclature and Database Project:vascular rings,tracheal stenosis,pectus excavatum[J].Annals of Thoracic Surgery,2000,69(3-supp-S1):308-318.DOI:10.1016/s0003-4975(99)01279-5.
5 Kir M,Saylam GS,Karadas U,et al.Vascular rings:presentation,imaging strategies,treatment,and outcome[J].Pediatric Cardiology,2012,33(4):607-617.DOI:10.1007/s00246-012-0187-x.
6 鲁力,杨小红,赵胜,等.胎儿单纯双主动脉弓的产前诊断与临床随访分析[J].中华超声影像学杂志,2018,27(12):1069-1074.DOI:10.3760/cma.j.issn.1004-4477.2018.12.012.Lu L,Yang XH,Zhao S,et al.Prenatal ultrasonic diagnosis and clinical follow-ups of isolated double aortic arch in infants[J].Chin J Ultrasonogr,2018,27(12):1069-1074.DOI:10.3760/cma.j.issn.1004-4477.2018.12.012.
7 Yang X,Ye J,Gao Z.Double aortic arch presenting with a foreign object in the oesophagus:a case report and imaging diagnosis[J].Cardiology in the Young,2017:1-3.DOI:10.1017/S1047951117000919.
8 饶姣,李虹,刘琴,等.54例婴儿先天性血管环的临床特征和治疗[J].中华胸心血管外科杂志,2018,34(11):679-682.DOI:10.3760/cma.j.issn.1001-4497.2018.11.010.Rao J,Li H,Liu Q,et al.Clinical characteristics and treatment of congenital vascular rings:a report of 54 infants[J].Chin J Thorac Cardiovasc Surg,2018,34(11):679-682.DOI:10.3760/cma.j.issn.1001-4497.2018.11.010.
9 吴娟,刘云,王铭,等.主动脉弓异常的产前超声诊断线索和技巧[J].中华超声影像学杂志,2018,27(10):846-850.DOI:10.3760/cma.j.issn.1004-4477.2018.10.004.Wu J,Liu Y,Wang M,et al.Clues and techniques of prenatal ultrasonographic diagnosis for fetal aortic arch anomalies[J].Chin J Ultrasonogr,2018,27(10):846-850.DOI:10.3760/cma.j.issn.1004-4477.2018.10.004.
10 贺新建,魏九茹,董凤群.超声心动图对小儿双主动脉弓的诊断价值[J].中华超声影像学杂志,2017,26(4):355-356.DOI:10.3760/cma.j.issn.1004-4477.2017.04.019.He XJ,Wei JR,Dong FQ.Diagnostic value of echocardiography in children with double aortic arch[J].Chin J Ultrasonogr,2017,26(4):355-356.DOI:10.3760/cma.j.issn.1004-4477.2017.04.019.
11 Evans WN,Acherman RJ,Ciccolo ML,et al.Vascular Ring diagnosis and management:notable trends over 25 years[J].World Journal for Pediatric and Congenital Heart Surgery,2016,7(6):717-720.DOI:10.1177/2150135116661279.
12 丁楠,李晓峰,郭健,等.婴幼儿双主动脉弓的诊断与手术治疗[J].中华胸心血管外科杂志,2016,32(3):140-142.DOI:10.3760/cma.j.issn.1001-4497.2016.03.004.Ding N,Li XF,Guo J,et al.Diagnosis and surgery of double aortic arch in infants and toddlers[J].Chin J Thorac Cardiovasc Surg,2016,32(3):140-142.DOI:10.3760/cma.j.issn.1001-4497.2016.03.004.
13 Backer CL,Mongé MC,Popescu AR,et al.Vascular rings[J].Seminars in Pediatric Surgery,2016,25(3):165.DOI:10.1053/j.sempedsurg.2016.02.009.
14 生蓉,莫绪明.双主动脉弓的外科治疗进展[J].中华胸心血管外科杂志,2016,32(4):253-256.DOI:0.3760/cma.j.issn.1001-4497.2016.04.019.Sheng R,Mo XM.Advance in surgical treatment of double aortic arch[J].Chin J Thorac Cardiovasc Surg,2016,32(4):253-256.DOI:10.3760/cma.j.issn.1001-4497.2016.04.019.
15 Seo HS,Park YH,Lee JH,et al.A case of balanced type double aortic arch diagnosed incidentally by transthoracic echocardiography in an asymptomatic adult patient[J].Journal of Cardiovascular Ultrasound,2011,19(3):163-166.DOI:10.4250/jcu.2011.19.3.163.
16 Kajikawa,Yutaka,Takemoto,et al.Asymptomatic double aortic arch[J].Int Med Case Rep J,2010,3:63-66.DOI:10.2169/internalmedicine.44.356.
Memo
收稿日期:2020-02-15。
通讯作者:陈文娟,Email:chenwjok@126.com