Pediatric Heart Expert Forum
ARSA
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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ARSA

hi there,
               im 26 weeks pregnant and on my last scan they found a aberrant right subclavian artery, i dont reallyknow what this means, they explained that my odds for downsyndrome go up had to go for cardiac scan and they could not find any other problems with the heart. what are my chances of having a child with prolems or downsyndrome, nothing has reall been explained to me or what to do next they said im still low risk at 1-600 of downs and suggested not to do invaisive testing, but what do i do now? just sit and wait till my baby is born?? please help
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Dear Mougle,

The right subclavian artery (RSCA) is one of the arteries that arise from the arch of the aorta (the main artery that takes blood out of the left side of the heart to feed the body).  The aorta comes up out of the heart, gives off several arteries to feed the head and neck, including the RSCA, then turns downward to deliver blood to the rest of the body.  The RSCA typically comes off of the very first artery from the aortic arch and feeds the right arm.  In an aberrant RSCA, the artery arises further downstream on the arch, but still feeds the right arm.  However, it usually does not cause any problems, especially if the aortic arch is a left-sided arch.  The time that we can see a problem called a vascular ring is when the aortic arch is RIGHT sided and the aberrant subclavian is the LEFT.  This ring can cause compression of the airway and/or the esophagus.  With an otherwise structurally normal heart, isolated aberrant RSCA is found in 0.6-1.4% of the general population as a normal variant.  It is also seen in somewhat higher numbers in patients with Trisomy-21 (Down syndrome) as well as chromosome 22q11 deletion (DiGeorge syndrome), even with an otherwise structurally normal heart.

At this point, it is not hurting your baby, nor should it cause problems for your baby after the baby is born.  Therefore, anything else to do at this time would just be genetic testing.  The decision for this is up to you and you OB to discuss, including deciding how the benefits and the risks of invasive testing (amniocentesis) balance as well as what you would do with the information once you had it.  There are some people who would terminate a pregnancy if they got an abnormal genetic diagnosis and others who would not.  However, at 26 weeks gestation, you are pretty much past the window of considering termination.  Some people decide to wait until the baby is born and to wait for the initial examination is performed before deciding on further testing.  This is obviously a personal/family decision that I cannot necessarily help you with, as I don’t otherwise have all the information about your baby.  The good news here is that no surgical intervention should be needed for your baby’s heart.

It is important that you make sure that you feel comfortable with your OB staff and the discussions that you have with them.  If you feel that you are not getting enough information or that your questions are not being answered, do not hesitate to get a second opinion.
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