High incidence of progressive stenosis in aberrant left subclavian artery with right aortic arch
High incidence of progressive stenosis in aberrant left subclavian artery with right aortic arch
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DOI：
10.1007/s00380-017-1056-6
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发表时间：
2018-03-01
影响因子：
1.5
通讯作者：
Ohga, Shouichi
中科院分区：
文献类型：
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作者：
Muraoka, Mamoru;Nagata, Hazumu;Ohga, Shouichi
摘要右主动脉弓合并左锁骨下动脉是一种罕见的主动脉弓异常。aLSCA狭窄与RAA/aLSCA的临床相关性尚未完全阐明。本研究的目的是研究产前诊断为RAA/aLSCA的婴儿aLSCA狭窄的诊断、发生率、管理和结局。入选了2011年1月至2014年12月期间在九州大学医院诊断为RAA/aLSCA的10例胎儿。回顾了母亲和儿童的病历，以调查性别、胎儿诊断时的胎龄、出生时的胎龄和体重、计算机断层扫描（CT）、椎动脉多普勒超声和血管造影的结果以及aLSCA狭窄的并发症和结局。10例患者中有8例在出生后首次CT检查时发现aLSCA狭窄。无患者发生吞咽困难或呼吸窘迫。3例患者的狭窄自行消退。其余5例患者中有4例aLSCA狭窄进展，包括1例发生完全闭塞的病例-该病例与供应远端LSCA的左椎动脉的逆行血流有关。球囊血管成形术成功用于治疗2例狭窄。所有患者均未出现锁骨下动脉盗血现象和发育问题。出生后80%的RAA/aLSCA患者发现aLSCA狭窄。在心血管和脑血管系统发育过程中，可能需要对狭窄病变进行早期检测和选择性治疗，以防止完全闭塞。
Right aortic arch with aberrant left subclavian artery (RAA/aLSCA) is a rare aortic arch anomaly. The clinical association of aLSCA stenosis with RAA/aLSCA has not yet been fully elucidated. The aim of this study was to investigate the diagnosis, incidence, management and outcome of aLSCA stenosis in infants with prenatally diagnosed RAA/aLSCA. Ten fetuses who were diagnosed as having RAA/aLSCA in Kyushu University Hospital between January 2011 and December 2014 were enrolled. The maternal and child medical records were reviewed to investigate sex, gestational age at the fetal diagnosis, gestational age and body weight at birth, the findings of computed tomography (CT), Doppler ultrasonography of the vertebral artery and angiography, and the complications and outcomes of aLSCA stenosis. In 8 of 10 patients, aLSCA stenosis was identified on the first CT examination after birth. No patients had dysphagia or respiratory distress. The stenosis spontaneously resolved in 3 patients. In 4 of the 5 remaining patients, aLSCA stenosis progressed, including one case in which complete occlusion occurred-the case was associated with retrograde flow from the left vertebral artery supplying the distal LSCA. Balloon angioplasty was successfully used to treat stenosis in two cases. The subclavian steal phenomenon and developmental problems were not observed in any patients. aLSCA stenosis was identified in 80% of patients with RAA/aLSCA after birth. The early detection and elective treatment of stenotic lesions may be required to prevent complete occlusion during the development of the cardiovascular and cerebrovascular systems.