Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

09 l pasquini anelli vascolari

1,008 views

Published on

  • Hello! Who wants to chat with me? Nu photos with me here http://bit.ly/helenswee
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

09 l pasquini anelli vascolari

  1. 1. Fetal Diagnosis of Complete Vascular Ring in Right Aortic Arch and Left Ductus Arteriosus LUCIANO PASQUINI MD Director Perinatal Cardiology Bambino Gesu’Hospital Rome April 18-19 2015 “ La Sapianza” University , Rome
  2. 2. Anatomy of Ductus Arteriosus in Right Aortic Arch Anatomic Patterns L.Knight et al. Right Aortic Arch. Circulation 1974
  3. 3. Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus Complete Vascular Rings DAA RAA, LDA, ALSA RAA, LDA
  4. 4. Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus Embriology
  5. 5. Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus Anatomy
  6. 6. Postnatal Diagnosis Right Aortic Arch and Left Ductus Arteriosus • Symptoms • CTScan / MRI • Rare Kommerell Diverticulum
  7. 7. Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus PA T Normal “V” Shape RAAsvc RAA and a LDA ,”U” Shape
  8. 8. Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus PAT RAA with Aberrant LSA and LDA
  9. 9. Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus PAT RAA with Aberrant LSA and LDA
  10. 10. Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus PAT RAA with Aberrant LSA and LDA
  11. 11. Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus PAT RAA with Aberrant LSA and LDA
  12. 12. Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus PAT RAA with Aberrant LSA and LDA
  13. 13. STUDY POPULATION • January 2008 - April 2014 • 19 pts • 7 with prenatal diagnosis (ga 26.9±5.28 weeks) • 12 with postnatal diagnosis Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus
  14. 14. Methods • Fetal or Postnatal Diagnosis • Prenatal and Postnatal Echocardiography • CTScan / MRI • Prenatal and Postnatal Medical, Genetic and Surgical Reports Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus
  15. 15. FETAL POPULATION • all Asyntomatic • 2 Surgery Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus RESULTS 1 POSTNATAL POPULATION • 9/12 Syntomatic • 9/12 Surgery
  16. 16. • 11/19 Tracheal Compression by CT scan (9 symtomatic) 9/12 postnatal 2/7 fetal • 11/19 Surgical Resection Left Ligamentum (only one with residual significant Tracheomalacy) Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus RESULTS 2
  17. 17. Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus
  18. 18. • 17/19 Normal Inracardiac Anatomy • 2/19 Associated VSD • 3/19 Genetic Syndrome (2 DiGeorge S.,1 Goldenhar S.) Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus RESULTS 3
  19. 19. Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus • Definition • Medial Necrosis • Primary Resection Kommerell Diverticulum Trends in vascular ring surgery , C.L. Backer et al JTCVS 2005 Reoperation afther Vascular Ring Repair , C.L. Backer et al STCSPCSA 2014
  20. 20. • Frequency is unknown but is certainly higher than previously reported • Postnatal Diagnosis can be difficult while Fetal Diagnosis is much easier • CT/MRI is recommended • Long Term Follow-up is necessary • There is a small subgroup of asyntomatic patients with severe tracheal stenosis • Kommerell Diverticulum Resection is recommanded Fetal Diagnosis Right Aortic Arch and Left Ductus Arteriosus Conclusions
  21. 21. Thank you all !!
  22. 22. THANK YOU ALL !!
  23. 23. Grazie a Tutti !

×