Imaging the fetal aortic arch and its branching pattern in a mid-trimester screening population

Abstract

Purpose

Aortic arch branching variants have recently been found to have an impact in neonates undergoing surgical interventions involving the thoracic aorta such as aortic coarctation repair. They have been described prenatally in 6% of neonates, whereas they occur in up to 26% postnatally. To explore whether the branching variations might have been underdiagnosed in utero, we comprehensively assessed the aortic arch and its branching patterns in a low-risk population between the 19^th and 22^nd week of gestation.

Materials and Methods

This prospective cohort study included 139 low-risk singleton pregnancies. During a standardized fetal echocardiography examination, we investigated the aortic arch in a sagittal view according to predefined landmarks. Based on video clips, its branching pattern was categorized as normal branching or branching variants by 2 operators who were blinded to each other.

Results

Classification of aortic arch branching was achieved in 127/139 cases (91.4%). 103 cases (81.1%) showed a normal pattern, and 24 cases (18.9%) showed a branching variant. Both operators agreed on 18 brachiobicephalic trunks (the so-called bovine arch), 4 aberrant left vertebral arteries, 1 aortic arch with 5 branching vessels. In 1 case there was disagreement regarding the type of variant.

Conclusion

Prenatal targeted echocardiography could identify 18.9% prevalence of aortic arch branching variants in a low-risk population. Future studies are warranted to assess the clinical impact of our findings on neonates with congenital heart defects.

Zusammenfassung

Hintergrund

Gefäßvarianten der thorakalen Aorten-Abgänge wurden als Risikofaktoren für Neugeborene identifiziert, die eine Intervention der Aorta, zum Beispiel bei Aorten-Isthmus-Stenose, vor sich haben. Pränatal wurde die Häufigkeit mit bis zu 6% beschrieben, während sie postnatal in bis zu 26% gefunden wurden. Um zu untersuchen, ob die Varianten bisher in utero unterdiagnostiziert wurden, untersuchten wir den Aortenbogen und die Abgänge in einer Niedrig-Risikogruppe zwischen der 19. und der 22. SSW (Schwangerschaftswoche).

Material und Methoden

Diese prospektive Kohortenstudie umfasste 139 Einlingsschwangerschaften mit niedrigem Risiko. Während einer standardisierten fetalen Echokardiografie untersuchten wir den Aortenbogen in sagittaler Ebene. Anhand von Videoclips wurden die Abgänge der Aorta von 2 Untersuchenden, die zueinander verblindet waren, entweder als normales Abgangsmuster oder als Variante klassifiziert.

Ergebnisse

Die Klassifizierung der Abgänge der fetalen Aorta gelang in 127/139 (91,4%) der Fälle. In 103 Fällen (81,1%) wurde ein normales Abgangsmuster beobachtet, während in 24 Fällen (18,9%) eine Variante vorlag. In 18 Fällen wurde ein Truncus brachiobicephalicus (ein sogenannter boviner Aortenbogen), in 4 Fällen eine aberrante linke Vertebral-Arterie und in einem Fall wurde ein Aortenbogen mit 5 abgehenden Gefäßen gefunden. In einem Fall waren die Untersuchenden bezüglich der Variante uneinig.

Schlussfolgerung

Die gezielte pränatale Echokardiografie konnte in einer Niedrig-Risikopopulation eine Prävalenz von 18,9% für Varianten der Abgänge des Aortenbogens identifizieren. Zukünftige Studien sind erforderlich, um die klinischen Auswirkungen unserer Ergebnisse auf Neugeborene mit angeborenen Herzfehlern zu bewerten.

Keywords

aortic arch branching - bovine aortic arch - brachiobicephalic trunk - fetal aortic arch - aortic arch variants

Publication History

Received: 22 October 2024

Accepted after revision: 27 February 2025

Accepted Manuscript online:
27 February 2025

Article published online:
09 September 2025

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