Echocardiographic Diagnosis And Missed Diagnosis Or Misdiagnosis Of Right Aortic Arch With Vascular Ring In Children

Objective:To explore the value of ultrasonography in the diagnosis of vascular ring which formed by right aortic arch with aberrant artery or mirror-image right aortic arch and left ductus arteriosus or arterial ligament.Method:43 cases right aortic arch with vascular ring confirmed by surgery were analyzed retrospectively.We reviewed the UCG and CTA characteristics of this disease with the surgical results as the gold standard.Result:Among the 43 right aortic arch with vascular ring’s patients,36 cases were right aortic arch(RAA)with aberrant left subclavianartery(ALSA),ultrasound sensitivity was69.4%(25/36),missed diagnosis rate was 25%(9/36):ultrasound was only diagnosed as RAA,misdiagnosis rate was 5.6%(2/36): ultrasound was both misdiagnosed as mirror-image right aortic arch;4 cases were RAA with aberrant left innominate artery(AL-In A),the sensitivity was 100%(4/4);3 cases were mirror-image right aortic arch,sensitivity was 33.3%(1/3),misdiagnosis rate was 66.7%(2/3): one case was misdiagnosed as double aortic arch(DAA),the other case was misdiagnosed as RAA with ALSA.All the right aortic arch with vascular ring cases were diagnosed by CTA.There were 26 cases of intracardiac malformations in 43 children,ultrasound diagnosis was correct,the missed diagnosis and misdiagnosis rate of CTA was 11.5%.Conclusion:Right aortic arch with vascular ring is not uncommon in children,especially vascular ring which formed by RAA with ALSA and left arterial ligament.Because of the limitations of ultrasound in extracardiac vascular exploration,it is easy to lead to missed diagnosis or misdiagnosis.The keys to accurate diagnosis of the disease are clearly visualization of the innominate arteryand the relationship with descending aorta and aberrant artery by scanning different views.