P04.01: Aberrant right subcalvian artery: prenatal diagnostic—routine exam or challenge?

The purpose of this work is to underline the possibilities of prenatal diagnostic of aberrant right subclavian artery (ARSA) in routine prenatal diagnostic in the second trimester of pregnancy, by using colour Doppler in the three vessels + trachea view. Extended fetal echocardiography was performed. For identification of ARSA colour Doppler was used systematically in the three vessels + trachea view. For differential diagnosis between ARSA and hemiazygos vein was performed pulsating Doppler. In all cases with ARSA amniocentesis and FISH test were recommended. In cases with associated aneuploidies or heart disease therapeutic abortions followed by morphopathologic examination of the fetus were performed. Alive newborns underwent clinical examination in order to reveal signs of compression on trachea or esophagus. Between 03.01.2010–28.02. 2011 we performed 1092 routine fetal morphologies. We identified 12 cases with ARSA. In 2 cases ARSA was associated with atrioventricular septal defect. One of the fetuses presented trisomy 21. In both cases termination of pregnancy was performed. Only one of the patients gave her consent for necropsy examination of the fetus, which confirmed the prenatal diagnosis. The remaining 10 cases presented isolated ARSA. Four patients accepted the amniocentesis and FISH test, which were normal. Seven pregnant patients delivered at term. The neonates did not present clinical findings suggesting compression on the trachea or esophagus. Three cases of isolated ARSA are still in evolution. Colour Doppler in three vessels + trachea view is a relatively simple exam which can be recommended as a routine test to be performed within extensive fetal echocardiographic examination. Association of ARSA with cardiac anomalies represents a high risk factor for aneuploidy. More prospective studies need to be performed in order to evaluate the risk of aneuploidy in cases with isolated ARSA.