Scholarlink

<p>To establish objective criteria for predicting postnatal respiratory symptoms and determine surgical indications in fetuses with double aortic arch (DAA). This single-center, retrospective cohort study included fetuses diagnosed with DAA using fetal echocardiography and managed perinatally at Kanagawa Children’s Medical Center from January 2013–December 2024. Clinical data, fetal echocardiography, postnatal contrast-enhanced computed tomography (CT) findings, surgical intervention, and outcomes were reviewed. Narrowest tracheal diameter (NTD) Z score in late gestation and narrowest-to-reference tracheal area (NTA/RTA) ratio on postnatal CT were measured. Primary and secondary outcomes included respiratory symptoms shortly after birth and elective surgery, respectively. Groups were compared using t-tests, and the optimal cutoff values were determined using receiver operating characteristic (ROC) curve analysis. Reproducibility was assessed using intraclass correlation coefficient. Twenty-two patients were included: 5 symptomatic and 17 asymptomatic (12, prophylactic surgery; 5, observation). Symptomatic patients had significantly lower NTD Z scores (median − 1.8 vs. −1.2, <i>P</i> = 0.012) and NTA/RTA ratios (median 0.39 vs. 0.67, <i>P</i> &lt; 0.001). NTD Z score ≤ − 1.7 (area under the ROC curve [AUC] 0.87; sensitivity 80%, specificity 88%) and NTA/RTA ratio ≤ 0.5 (AUC 0.94; sensitivity 100%, specificity 82%) were optimal thresholds for predicting early symptoms. In the asymptomatic group, NTA/RTA ratio ≥ 0.56 identified candidates for observation without surgery. The ICC values for both parameters exceeded 0.85, indicating excellent reproducibility. The prenatal NTD Z score and postnatal NTA/RTA ratio accurately predict postnatal respiratory symptoms in fetuses with DAA. These quantitative parameters may guide individualized perinatal management and surgical decision-making.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Prediction of Symptoms and Evaluation of Surgical Indications After Birth Based on Tracheal Morphology of Double Aortic Arch

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年1月12日

查看全文
  • Takeshi Ikegawa,
  • Akio Kato,
  • Motoyoshi Kawataki,
  • Yoshinori Inagaki,
  • Katsuaki Toyoshima,
  • Hideaki Ueda

摘要

To establish objective criteria for predicting postnatal respiratory symptoms and determine surgical indications in fetuses with double aortic arch (DAA). This single-center, retrospective cohort study included fetuses diagnosed with DAA using fetal echocardiography and managed perinatally at Kanagawa Children’s Medical Center from January 2013–December 2024. Clinical data, fetal echocardiography, postnatal contrast-enhanced computed tomography (CT) findings, surgical intervention, and outcomes were reviewed. Narrowest tracheal diameter (NTD) Z score in late gestation and narrowest-to-reference tracheal area (NTA/RTA) ratio on postnatal CT were measured. Primary and secondary outcomes included respiratory symptoms shortly after birth and elective surgery, respectively. Groups were compared using t-tests, and the optimal cutoff values were determined using receiver operating characteristic (ROC) curve analysis. Reproducibility was assessed using intraclass correlation coefficient. Twenty-two patients were included: 5 symptomatic and 17 asymptomatic (12, prophylactic surgery; 5, observation). Symptomatic patients had significantly lower NTD Z scores (median − 1.8 vs. −1.2, P = 0.012) and NTA/RTA ratios (median 0.39 vs. 0.67, P < 0.001). NTD Z score ≤ − 1.7 (area under the ROC curve [AUC] 0.87; sensitivity 80%, specificity 88%) and NTA/RTA ratio ≤ 0.5 (AUC 0.94; sensitivity 100%, specificity 82%) were optimal thresholds for predicting early symptoms. In the asymptomatic group, NTA/RTA ratio ≥ 0.56 identified candidates for observation without surgery. The ICC values for both parameters exceeded 0.85, indicating excellent reproducibility. The prenatal NTD Z score and postnatal NTA/RTA ratio accurately predict postnatal respiratory symptoms in fetuses with DAA. These quantitative parameters may guide individualized perinatal management and surgical decision-making.