Arch Dis Child. 2020 Oct 28;archdischild-2020-318946. doi: 10.1136/archdischild-2020-318946. Online ahead of print.
PMID: 33115711 DOI: 10.1136/archdischild-2020-318946
Take Home Points:
- 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.
- Genetic testing may be offered following detection of double aortic arch.
Commentary from Dr. Manoj Gupta (New York, USA), section editor of Pediatric & Fetal Cardiology Journal Watch: In this interesting study, the authors performed a retrospective review of the postnatal outcome for prenatally diagnosed double aortic arch.
Data was collected from two fetal cardiology units from 2014 to 2019, 50 cases were identified prenatally and 48 had postnatal follow-up. 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). 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).