Isolated vascular rings in an era of high prenatal diagnosis rates: a review

INTRODUCTION: Over the past ten years, advances in prenatal diagnosis have led to a steady increase in newborn patients with isolated vascular rings (VR). Fetal echocardiography allows us to change the natural history of patients with VR due to timely diagnosis and the possibility of earlier surgical intervention, probably even before the clinical manifestation of the defect in certain anatomical groups. However, how best to diagnose and treat these children remains uncertain.

OBJECTIVE: To assess the impact of prenatal diagnosis on postnatal management of newborns with isolated VR according to the available literature.

MATERIALS AND METHODS: A literature search was performed in Russian and English for the period from 2010 to 2023 in Medline/PubMed, RSCI/Elibrary databases by keywords: vascular ring, double aortic arch, right aortic arch, aberrant subclavian artery, Kommerell’s diverticulum, newborn, surgical treatment, fetal echocardiography.

RESULTS: At the present stage, there is no mention of vascular rings in national recommendations, that is, there is no generally accepted clinical and diagnostic tactics for managing patients with VR. A review of the present data will help provide recommendations regarding the optimal management of neonates with prenatally diagnosed VR.

CONCLUSION: Advances in fetal imaging provide an opportunity to better understand the anatomical spectrum of nonobstructive aortic arch anomalies, clinical presentation, and need for surgical intervention in an emerging cohort of patients. The accumulation of knowledge and improvement of diagnostic and treatment capabilities dictates the need to analyze and rethink the currently available scientific information on the feasibility and methods of postnatal diagnosis verification, as well as determining indications for surgical treatment in the modern population of patients with VR in order to select the optimal approach and improve the expected treatment results.

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