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Evaluation of the Trachea in Fetuses with Double Aortic Arch Using Prenatal Ultrasound: A Retrospective Cohort Study
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  • Xia Yin,
  • Yan Liu,
  • LiHong Wu,
  • Qiao Zheng,
  • Ruan Peng,
  • HongNing Xie
Xia Yin
Sun Yat-sen University First Affiliated Hospital
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Yan Liu
Dalian Municipal Women and Children’s Medical Center
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LiHong Wu
Sun Yat-sen University First Affiliated Hospital
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Qiao Zheng
Sun Yat-sen University First Affiliated Hospital
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Ruan Peng
Sun Yat-sen University First Affiliated Hospital
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HongNing Xie
Sun Yat-sen University First Affiliated Hospital

Corresponding Author:[email protected]

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Abstract

Objectives: To evaluate the tracheal compression caused by the vascular ring in fetuses with double aortic arch (DAA) using prenatal ultrasound and to analyze the relationship between tracheal compression and postnatal clinical symptoms. Design: Retrospective cohort study. Setting: Two fetal medical centre in China. Population: 26 fetuses with DAA diagnosed with prenatal ultrasound and 334 singleton pregnancies with normal fetuses. Methods: The tracheal compression—evaluated by comparing the tracheal internal diameter Z-scores against the GA—was assessed in the fetuses with DAA and in normal fetuses. The live-born infants with DAA were divided into symptomatic and asymptomatic groups for the comparative analysis of Z-scores. Results: 26 fetuses with DAA were diagnosed and 14 (53.8%) fetuses with DAA were delivered alive. Among the 14 live-born infants, 7 (50.0%) were symptomatic while 7 (50.0%) were asymptomatic. The tracheal internal diameter Z-scores were significantly lower in the DAA group than in the normal groups (-0.6 [-1.0, -0.1] vs. 0.0 [-0.3, 0.3], P<0.001). Compared to the asymptomatic group, the tracheal internal diameter Z-scores were significantly lower in the symptomatic group (-1.5 [-1.8, -1.1] vs. -0.6 [-0.9, -0.1], P=0.018). Conclusions: The clinical symptoms in the infants with DAA were associated with prenatal tracheal compression, which can be prenatally evaluated using ultrasound. If fetuses are diagnosed with DAA, prenatal surveillance of the tracheal internal diameters and comparison with Z-score reference ranges could provide pertinent information that would aid perinatal clinical management.