Abstract
Aortic abnormalities are being diagnosed more frequently during fetal life due to the incorporation of views of the upper mediastinum into screening views of the fetal heart. Morbidity and mortality is reduced when duct-dependent lesions such as coarctation of the aorta are prenatally diagnosed and lesions such as double aortic arch and right aortic arch are of clinical significance because they can cause airway compression. Abnormalities of the aortic arch and an aberrant right subclavian artery can be associated with chromosomal abnormalities. All aortic arch abnormalities can be associated with intracardiac abnormalities so assessment of the intracardiac anatomy is mandatory. This chapter however focuses on isolated abnormalities of the aortic arch and its branches.
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Four chamber view demonstrating ventricular disproportion. The right atrium and ventricle are wider than the left atrium and ventricle. The left ventricle does reach the apex however (MP4 3814 kb)
Sweep from the three-vessel to three vessel and tracheal view showing arterial disproportion. The pulmonary artery is larger than the ascending aorta and the arterial duct is larger than the transverse aortic arch which is difficult to appreciate on 2D (MP4 3802 kb)
Sweep from the left ventricular outflow tract view to the three vessel and tracheal view showing arterial disproportion. The pulmonary artery is larger than the aorta and the arterial duct is larger than the transverse aortic arch. Colour flow mapping shows there is antegrade flow across the slender transverse aortic arch (MP4 2600 kb)
A modified view showing the short axis of the heart. In the centre of the picture is a bicuspid aortic valve (MP4 2303 kb)
Sweep from the four-chamber view to the three vessel and tracheal view showing ventricular and arterial disproportion. A dilated coronary sinus can be seen on the four-chamber view. The three-vessel view shows 4 vessels—the fourth vessel is the persistent left superior vena cava. The transverse aortic arch is slender (MP4 6155 kb)
Three vessel and tracheal view demonstrating a right sided aortic arch. The arterial duct passes to the left of the trachea and then behind it to join with the aortic isthmus on the right (MP4 9635 kb)
Three vessel and tracheal view with colour flow mapping. This demonstrates antegrade flow in the right aortic arch and the left arterial duct (MP4 4734 kb)
Three vessel and tracheal view with colour flow mapping demonstrating antegrade flow in both the dominant right aortic arch and the slender left sided aortic arch. The left sided arterial duct is also visualised and shows antegrade flow (MP4 3291 kb)
Sweep from the four-chamber view to the three vessel and tracheal view with colour flow mapping. There is a normal four chamber view with no regurgitation, the aortic arch is left sided with normal flow pattern and the origin of the right subclavian artery is normal, passing anterior to the trachea (MP4 15281 kb)
Modified three vessel and tracheal view using colour flow mapping demonstrating a left sided aortic arch with an aberrant right subclavian artery passing behind the trachea. In order to obtain the aortic arch and the aberrant right subclavian artery in one view, the probe must be tilted (MP4 3266 kb)
Modified three vessel and tracheal view using colour flow mapping demonstrating a left sided aortic arch with an aberrant right subclavian artery passing behind the trachea. In order to obtain the aortic arch and the aberrant right subclavian artery in one view, the probe must be tilted (MP4 3757 kb)
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Vigneswaran, T., Zidere, V. (2018). Aortic Arch Abnormalities. In: Simpson, J., Zidere, V., Miller, O.I. (eds) Fetal Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-319-77461-9_9
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DOI: https://doi.org/10.1007/978-3-319-77461-9_9
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-77460-2
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