{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:40:13Z","timestamp":1792600813804,"version":"4.5.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Cardiol"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    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\u2019s Medical Center from January 2013\u2013December 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 \u2212\u20091.8 vs. \u22121.2,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.012) and NTA\/RTA ratios (median 0.39 vs. 0.67,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001). NTD Z score\u2009\u2264\u2009\u2212\u20091.7 (area under the ROC curve [AUC] 0.87; sensitivity 80%, specificity 88%) and NTA\/RTA ratio\u2009\u2264\u20090.5 (AUC 0.94; sensitivity 100%, specificity 82%) were optimal thresholds for predicting early symptoms. In the asymptomatic group, NTA\/RTA ratio\u2009\u2265\u20090.56 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.\n                  <\/jats:p>","DOI":"10.1007\/s00246-025-04153-4","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T15:34:00Z","timestamp":1768232040000},"page":"3502-3510","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prediction of Symptoms and Evaluation of Surgical Indications After Birth Based on Tracheal Morphology of Double Aortic Arch"],"prefix":"10.1007","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5465-2982","authenticated-orcid":false,"given":"Takeshi","family":"Ikegawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8727-5634","authenticated-orcid":false,"given":"Akio","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motoyoshi","family":"Kawataki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Inagaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuaki","family":"Toyoshima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideaki","family":"Ueda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"4153_CR1","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1002\/ppul.23152","volume":"50","author":"A Licari","year":"2015","unstructured":"Licari A, Manca E, Rispoli GA, Mannarino S, Pelizzo G, Marseglia GL (2015) Congenital vascular rings: a clinical challenge for the pediatrician. Pediatr Pulmonol 50:511\u2013524. https:\/\/doi.org\/10.1002\/ppul.23152","journal-title":"Pediatr Pulmonol"},{"key":"4153_CR2","doi-asserted-by":"publisher","first-page":"2028","DOI":"10.1002\/ppul.24490","volume":"54","author":"A Depypere","year":"2019","unstructured":"Depypere A, Proesmans M, Cools B, Vermeulen F, Daenen W, Meyns B, Rega F, Boon M (2019) The long-term outcome of an isolated vascular ring\u2014a single-center experience. Pediatr Pulmonol 54:2028\u20132034. https:\/\/doi.org\/10.1002\/ppul.24490","journal-title":"Pediatr Pulmonol"},{"key":"4153_CR3","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1017\/S1047951125000356","volume":"35","author":"EE LaSalle","year":"2025","unstructured":"LaSalle EE, Tedla BA, Golding F, Boulil Z, Sun HY (2025) Are all rings created equal? a single centre experience of fetal and paediatric vascular rings. Cardiol Young 35:702\u2013710. https:\/\/doi.org\/10.1017\/S1047951125000356","journal-title":"Cardiol Young"},{"key":"4153_CR4","doi-asserted-by":"publisher","first-page":"1398623","DOI":"10.3389\/fmed.2024.1398623","volume":"11","author":"C Jiang","year":"2024","unstructured":"Jiang C, Ling W, Peng L, Guo S, Wu Q, Chen C, Chen F, Li H, Weng Z (2024) Evaluation of tracheal diameter and angles in fetuses with double aortic arch using prenatal ultrasound: implications for postnatal management. Front Med (Lausanne) 11:1398623. https:\/\/doi.org\/10.3389\/fmed.2024.1398623","journal-title":"Front Med (Lausanne)"},{"key":"4153_CR5","doi-asserted-by":"publisher","first-page":"44","DOI":"10.3390\/children3040044","volume":"3","author":"RS Loomba","year":"2016","unstructured":"Loomba RS (2016) Natural history of asymptomatic and unrepaired vascular rings: is watchful waiting a viable option? a new case and review of previously reported cases. 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Information regarding this study is available on the Kanagawa Children\u2019s Medical Center website (\n                      \n                      ).","order":3,"name":"Ethics","label":"Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The requirement for consent to publish was waived, and an opt-out approach was applied in accordance with the approval of the Research Ethics Committee of the Kanagawa Children\u2019s Medical Center.","order":4,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The requirement for informed consent was waived, and an opt-out approach was applied.","order":5,"name":"Ethics","label":"Informed Consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}