Prenatal diagnosis of vascular rings

The purpose of this series was to identify vascular rings prenatally on fetal echocardiograms.

We reviewed the fetal echocardiograms and clinical histories of 9 patients with a diagnosis of vascular rings at our institution from 2004 to 2009. Eight patients had a prenatal diagnosis by fetal echocardiography. One other patient who had undergone fetal echocardiography had a diagnosis of a vascular ring and a cervical arch only postnatally.

Among the 8 patients with a prenatal diagnosis (4 with a double aortic arch and 4 with a right aortic arch [RAA], an aberrant left subclavian artery, and a left ductus arteriosus [LDA]), the vascular ring was isolated in 4 and associated with other structural congenital heart disease in 4. In all 8 patients with a prenatal diagnosis, the vascular ring was identified by cephalad transducer sweeps from a 3-vessel view (3VV) with and without color Doppler imaging, which revealed vascular structures coursing around the trachea. Seven of these patients had postnatal confirmation of the abnormality (there was 1 pregnancy termination without autopsy). The only known vascular ring missed at fetal echocardiography but diagnosed after birth was that associated with a cervical RAA (which could not be visualized in cross-sectional sweeps) and an LDA evaluated only late in pregnancy. Only 3 of the 8 postnatally treated neonates had clinical symptoms of the vascular ring, and 5 underwent surgical division of the ring.

Vascular rings can be largely identified before birth with cephalad sweeps from the 3VV with attention to the relationship of the aortic and ductal arches to the trachea on fetal echocardiograms.