Aortic Anomalies Research Articles

Rare Presentation of Subclavian Artery Isolation in a Neonate With a Family History of Aortic Arch Anomalies

Isolation of the left subclavian artery is a rare aortic arch anomaly in which the artery originates from the pulmonary artery through a ductus arteriosus rather than the aorta. In neonates it is usually diagnosed incidentally with other aortic or cardiac anomalies and can be associated with chromosomal deletions. We describe an extremely rare presentation whereby subclavian artery isolation was presented with left arm ischemia in a 6-day-old child. There were also a concurrent right aortic arch, ventricular septal defect, persistent left superior vena cava, and both radial and ulnar artery hypoplasia. A family history of aortic arch anomalies with no known chromosomal aberration was also present, whereby all the male family members on the maternal side had undergone aorto-cardiac surgery as neonates. Diagnosis and surgical management are discussed.

Unusual Congenital Aortic Anomaly with Rare Common Celiamesenteric Trunk Variation: MR Angiography and Digital Substraction Angiography Findings

Magnetic resonance angiography and digital substraction angiography (DSA) findings in a case with a rare congenital thoracoabdominal aortic hypoplasia and common celiamesenteric trunk variation with occlusion of infrarenal abdominal aorta are described here. To our knowledge, this aortic anomaly has not been previously described in the English literature. DSA is the optimum imaging modality for determination of aortic hypoplasia, associated vascular malformations, collateral vessels, and direction of flow within vessels.

Ascending–descending aortic bypass with the aid of a heart-lifting device

Extra-anatomic aortic bypass from the ascending to the descending aorta is an alternative for repair of complex aortic anomalies. We describe a case of repair of recoarctation of the aorta through a median sternotomy and posterior pericardial approach in which surgical exposure of the retrocardiac aorta was obtained by means of a heart-lifting device (Starfish 2; Medtronic, Inc, Minneapolis, Minn) commonly used in off-pump coronary artery bypass grafting. A 70-year-old man was seen with dyspnea on exertion and intermittent claudication. He was hypertensive, in atrial fibrillation, and taking oral anticoagulants. His medical history included repair of aortic coarctation (end-to-end anastomosis) 29 years previously. Echocardiography showed left ventricular hypertrophy with moderately depressed left ventricular function (ejection fraction 40%). He underwent aortic angiography, which confirmed the diagnosis of aortic recoarctation with a gradient of 48 mm Hg across the coarctation. The thoracic descending aorta was tortuous (Figure 1). In view of the patient’s age and left ventricular impairment, it was decided that an extra-anatomic repair would be less harmful than a standard approach for recoarctation. He underwent reoperation through a median sternotomy. Cardiopulmonary bypass (aortic and right atrial cannulation) was instituted with a left ventricular vent through the right superior pulmonary vein. With the heart beating, the posterior pericardium was opened. Because of the tortuosity of the aorta, this was found lying on the right side of the spine. To provide a good, constant exposure, a suction heart-lifting system (Starfish 2) was applied to the apex of the heart, which was retracted cephalad. The view of the operative field was excellent (Figure 2). The esophagus was retracted, and the aorta was surrounded with tapes and partially clamped. A 20-mm vascular graft (Hemashield Platinum; Boston Scientific Medi-tech, Wayne, NJ) was anastomosed to the descending aorta. After repositioning of the heart, the graft was routed around the left margin of the heart, anterior to the main pulmonary artery, and anastomosed to the ascending aorta. The patient was weaned from cardiopulmonary bypass and made an uneventful recovery. He is symptom free and normotensive, with low doses of β-blockers, 6 months after the procedure. Vijayanagar and colleagues1Vijayanagar R. Natarajan P. Eckstein P.F. Bognolo D.A. Toole J.C. Aortic valvular insufficiency and postductal aortic coarctation in the adult combined surgical management through median sternotomy—a new surgical approach.J Thorac Cardiovasc Surg. 1980; 79: 266-268PubMed Google Scholar reported a novel extra-anatomic surgical approach for repair of aortic coarctation through a median sternotomy. Procedures of bypass from the ascending aorta to the abdominal aorta2Wukasch D.C. Cooley D.A. Sandiford F.M. Nappi G. Reul Jr, G.J. Ascending aorta–abdominal aorta bypass indications, technique and report of 12 patients.Ann Thorac Surg. 1984; 37: 261-263Abstract Full Text PDF PubMed Scopus (35) Google Scholar and combined left thoracotomy and median sternotomy3Jacob T. Cobanoglu A. Starr A. Late results of ascending aorta–descending aorta bypass graft for recurrent coarctation of the aorta.J Thorac Cardiovasc Surg. 1998; 95: 782-787Google Scholar have also been described. However, the posterior pericardial approach limits the procedure to a single incision, and it is especially convenient when concomitant cardiac procedures must be performed. Favorable long-term results as late as 22 years have recently been reported.4Almeida de Oliveira S. Lisboa L.A. Dallan L.A. Abreu CA, F. Rochitte C.E. et al.Extraanatomic aortic bypass for repair of aortic arch coarctation via sternotomy. Midterm clinical and magnetic resonance imaging results.Ann Thorac Surg. 2003; 76: 1962-1966Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar In our case, we chose this approach because the patient had mild impairment of the left ventricular function, which precluded total aortic clamping proximal to the coarctation. We believed that cardiopulmonary bypass with a vented, beating heart would be the less deleterious of the available procedures. Operating on the recoarctation area could have been hazardous; we have previously encountered severe calcification of the distal aortic arch and left subclavian artery when repairing an aortic coarctation in patients older than 50 years.5Aris A. Subirana M.T. Ferres P. Torner-Soler M. Repair of aortic coarctation in patients more than 50 years of age.Ann Thorac Surg. 1999; 67: 1376-1379Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar Most groups favor positioning the graft in the right side of the pericardium, either posterior or anterior to the inferior vena cava. In our case, however, the aorta was extremely displaced to the right, and directing the graft toward that side would have resulted in a position prone to kinking. The use of a suction heart-lifting device provided an excellent exposure with steady retraction of the heart without damaging it, avoiding crowding of the operative field with the hand of an assistant during the distal anastomosis. It is possible that with the aid of this device the procedure can be performed off pump in selected cases. Drs Aris, Cobiella, Maestre, and Subirana (left to right)

Evaluation by magnetic resonance imaging of aortic dilatation and coarctation in adult Turner syndrome patients

Turner syndrome has well-recognized cardiovascular complications that appear in up to 40% of the patients and are more common in monosomy X. Left-sided obstructive lesions are relatively more frequent and predispose to aortic root dilatation and life-threatening aortic dissection. However, bicuspid aortic valves, hypertension, coarctation and aortic stenosis are also at risk of aortic dissection. Currently there is no clear guideline regarding the best single test for detection or monitoring aortic disease progression. Routine thoracic aortic magnetic resonance imaging (MRI) was introduced to the dedicated Turner syndrome clinic, with repeated MRI examination every 2 years to detect or assess progression of aortic lesions. Seven out of a total of 17 patients developed aortic anomalies during the course of surveillance, which included coarctation as well as aortic dilatation. None of these patients had any cardiovascular symptoms and the vascular abnormalities were detected on MRI at presentation or during the course of their follow-up. In patients with previously normal aortic imaging, the time interval for the lesion to be detectable varied between 2 and 6 years. In one patient there was progression of an established lesion over the 2-year period. In the few patients presented here, regular imaging at first consultation followed by every 2 years would appear to be warranted, although the exact frequency of imaging and by what modality still need to be ascertained definitively.

Angiography and Dynamic Airway Evaluation with MDCT in the Diagnosis of Double Aortic Arch Associated with Tracheomalacia

3Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. ouble aortic arch is a well-known congenital vascular anomaly causing extrinsic tracheal compression in neonates that can present with life-threatening episodes of stridor, cyanosis, or apnea. Surgical correction of the underlying vascular ring is the key for successful treatment for such patients [1]. However, previous studies have shown that as many as 30% of pediatric patients might still have persistent airway obstruction after surgical procedures [2, 3]. These symptoms may be related to airway wall weakening as a result of long-standing extrinsic airway compression. Such patients may benefit from undergoing a second operation after evaluation with both bronchoscopy and cross-sectional imaging. Recently, MDCT with multiplanar and 3D reconstruction has become an important tool in the evaluation of thoracic aortic anomalies in pediatric patients, obviating conventional angiography [4, 5]. Dynamic inspiratory–expiratory imaging by MDCT has been shown to be a promising method in the evaluation of patients with dynamic airway obstruction and to correlate well with bronchoscopic results [6]. In this case report, we describe the preand postoperative MDCT angiography findings in an infant with double aortic arch who failed extubation after undergoing corrective surgery. A dynamic airway evaluation was performed during the same setting of MDCT angiography by alternately applying and withholding positive-pressure ventilation, which simulated the inspiratory–expiratory scan. The child was found to have tracheomalacia, which explained the airway obstruction that persisted postoperatively.

Early surgical management of congenital aortic arch complex anomalies

Early surgical management of congenital aortic arch complex anomalies

Major vascular anomalies in Turner syndrome: prevalence and magnetic resonance angiographic features.

Turner syndrome (TS) is associated with aortic coarctation and dissection; hence, echocardiographic evaluation of all patients is currently recommended. X-ray angiography in clinically symptomatic patients has suggested a range of other vascular anomalies, but the true prevalence of such lesions in TS is unknown. To better understand the prevalence and pathogenesis of cardiovascular defects in TS, we prospectively evaluated a group of asymptomatic adult volunteers with TS using magnetic resonance (MR) angiography. A total of 85 adults with TS and 27 normal female adult volunteers underwent gadolinium-enhanced 3D MR angiography. A high prevalence of aortic anomalies was seen in women with TS, including elongation of the transverse arch (49%), aortic coarctation (12%), and aberrant right subclavian artery (8%). Venous anomalies were also prominent, including persistent left superior vena cava (13%) and partial anomalous pulmonary venous return (13%). None of these anomalies were found in healthy female controls. The constellation of elongation of the transverse arch, aortic coarctation, and persistent left superior vena cava was significantly associated with women with TS. Neck webbing and increased thoracic anterior-to-posterior dimension diameters were strong predictors for arterial and venous anomalies. Thoracic vascular anomalies are common in TS, occurring in approximately 50% of a group not preselected for cardiovascular disease. The highly significant association between neck webbing, increased chest diameter, and these vascular anomalies suggests that in utero, centrally localized lymphatic obstruction may contribute to these cardiovascular deformities in TS. Improved recognition of these often-undetected vascular lesions may be important for identification of patients in need of closer cardiovascular monitoring.

Laterality of the aortic arch and anomalies of the subclavian artery-reliable indicators for 22q11.2 deletion syndromes?

A variety of cardiac defects, encompassing truncus arteriosus, tetralogy of Fallot, pulmonary atresia with ventricular septal defect and interrupted aortic arch, are generally summarised as conotruncal malformations. Patients with these cardiac defects were frequently found to have a common microdeletion on chromosome 22, the so-called monosomy 22q11.2. The aim of our study was to determine whether the laterality of the aortic arch or the presence of subclavian artery anomalies (SAA) represent markers for monosomy 22q11.2 in these patients. 170 patients with these cardiac anomalies were recruited at presentation in the paediatric cardiology units of two tertiary referral centres from 1994 until 2003. Of the 170 children and young adults, 33 had interrupted aortic arch, 35 tetralogy of Fallot, 31 truncus arteriosus communis and 71 pulmonary atresia with ventricular septal defect. All were screened for monosomy 22q11.2 and the results were correlated with the laterality of the aortic arch and the presence of SAA contralateral to the aortic arch (aberrant origin from the descending aorta, isolation, distal ductal origin from the pulmonary artery and cervical origin of the right subclavian artery). Monosomy 22q11.2 was present in 59/170 patients (35%). A left aortic arch (LAA) was found in 118 (69%), a right aortic arch (RAA) in 52 (31%) patients. Almost 50% of the patients with RAA (46%), but only 30% of the patients with LAA had monosomy 22q11.2 ( P=0.054). A total of 47 patients (28%) had an anomaly of the subclavian artery, 81% of whom had monosomy 22q11.2. This deletion was found in decreasing percentage in patients with LAA+SAA (85%) >RAA+SAA (75%) >RAA without SAA (28%) >LAA without SAA (13%). In patients with conotruncal malformations, anomalies of the subclavian arteries are the most important anatomical marker for the presence of monosomy 22q11.2, independent of the laterality of the aortic arch. Therefore, we recommend cytogenetic testing for this microdeletion in all patients with subclavian artery anomalies and conotruncal malformations.

Patterns of congenital heart disease in unoperated adults: a 20-year experience in a developing country.

The number of patients with congenital cardiac disease reaching adulthood is increasing steadily. Many adults with such disease face both medical and surgical difficulties. This retrospective study was undertaken to assess the frequency and outcome of congenital heart disease (CHD) in unoperated adults. The charts of all patients with unoperated CHD, who were admitted to a tertiary care center in Beirut, Lebanon, between 1980 and 2000 were reviewed. Of these, 206 patients (52% men, age at admittance 18-71 years [32.8 +/- 13.3 years]) with a diagnosis of CHD were evaluated. Atrial septal defect (ASD) was the most common cardiac malformation with a relative frequency of 53%, followed by ventricular septal defects (11%), tetralogy of Fallot (11%), aortic anomalies (7%), pulmonary stenosis (6%), and Ebstein anomaly (4%). Most patients were symptomatic upon presentation, with dyspnea on exertion being the most common presenting symptom. Twenty-seven patients (13%) had cyanotic CHD. Of 179 acyanotic patients, 113 (63%), and 17 of 27 cyanotic patients (63%) underwent surgical intervention. In-hospital surgical complications for the acyanotic group included cerebrovascular accident (2%) and heart block (1%). Total surgical mortality was 4 of 130 (3%). One patient with tetralogy of Fallot presented with endocarditis and died. Atrial septal defect is the most common defect reported in our experience; however, it occurs more frequently than that reported in the literature. Although most patients were symptomatic on presentation, their functional status was stable. Accordingly, their hospital course, whether managed medically or surgically, held a relatively low complication rate. This could be attributed to the uncomplicated nature of pathologies in our series. The surgical mortality and in-hospital complications were slighter higher than those reported for similar lesions if repaired during childhood. This study reflects the relative frequency of various cardiac malformations in selected patients with "grown up" congenital heart disease (GUCH) and their natural survival pattern.

Does the incidence of two-vessel cord correlate with an increased incidence of discordance in twin gestations?

664 665 THE ACCURACY OF PRENATAL DIAGNOSIS OF FETAL HEART ANOMALIES IN THE OBESE GRAVIDA MAYRA TROYA-NUTT, ISRAEL HENDLER, SEAN BLACKWELL, MARJORIE TREADWELL, EMMANUEL BUJOLD, ROBERT SOKOL, YORAM SOROKIN, Wayne State University, Obstetrics/Gynecology, Detroit, MI Wayne State University, Obstetrics/ Gynecology/MFM, Detroit, MI OBJECTIVE: To compare the accuracy of prenatal ultrasound diagnosis for major fetal heart anomalies in obese and non-obese women. STUDY DESIGN: A computerized ultrasound and perinatal database was used to identify patients who had prenatally diagnosed major heart defects and delivered a live-born neonate at $24 weeks’ (10/1999-6/2003). Prenatal ultrasound reports were compared with neonatal examination including echocardiography. Demographic data, clinical characteristics, and outcome data were collected. Patients were divided into 2 groups based on body mass index (BMI). The agreement between prenatal and postnatal diagnosis was compared between obese (BMI$30 kg/m2) and non-obese patients (BMI < 30 kg/m2). RESULTS: Nineteen neonates met all study criteria. Prenatal diagnoses included left and right hypoplastic heart, atrial septal defect (ASD), ventricular septal defect (VSD), AV canal, tetralogy of Fallot, valvular or aortic anomalies. Of these, the diagnosis was confirmed postnatally in 12 (63%) cases. However, in obese patients 75% (6 of 8) newborns were found to have a normal cardiac evaluation postnatally, while only 1 of 11 newborns had a normal cardiac evaluation in non-obese gravidas (P = 0.004). Ventricular septal defect was the most frequently overdiagnosed anomaly (4 out of 7 cases, 57.1%); 1 case of ASD, 1 coarctation of the aorta, and 1 case of asymmetry between the right and the left heart. Volume 189, Number 6 Am J Obstet Gynecol SMFM Abstracts S239

Turner syndrome with complex mosaic monosomy and structural aorta anomalies

Turner syndrome with complex mosaic monosomy and structural aorta anomalies

Parental consanguinity and congenital heart malformations in a developing country.

The association between isolated congenital heart defects and consanguinity was examined in 759 Lebanese patients with different types of congenital heart malformations. The subjects were patients of the Children's Cardiac Registry Center (CCRC) at the American University of Beirut Medical Center. The proportion of first-cousin marriages among cardiac subjects was compared to that of the National Collaborative Perinatal Neonatal Network (NCPNN), after adjusting for the subjects' geographic distribution, and to the highest proportion reported by NCPNN. In general, the proportion of overall parental consanguinity and first-cousin matings among CCRC subjects (34.7 and 20.2%, respectively) were significantly higher than the highest proportion of first-cousin marriages reported by NCPNN (Bekaa subjects; 13.2%) (P < 0.0001). Comparison with the NCPNN-adjusted first-cousin mating proportion revealed a significantly increased rate of consanguinity in all categories of cardiac malformations except great vessel and coronary artery lesions (P < 0.05). The following lesions were significantly associated with increased parental consanguinity: aortic anomalies (aortic insufficiency, aortic stenosis, bicuspid aortic valve), atrial septal defect, double-outlet right ventricle, pulmonary atresia, patent ductus arteriosus, pulmonic stenosis, tetralogy of Fallot, and ventricular septal defect (P < 0.05). Higher maternal education was the only variable that was negatively correlated with parental consanguinity (P = 0.037). Our study emphasizes the role of homozygous recessive genes in the causation of different types of isolated congenital heart malformations, known to follow a multifactorial pattern of inheritance. There is an urgent need for educating the public on the deleterious effects of inbreeding, especially in developing countries with high overall consanguinity rates and limited financial resources.

Morphologic and functional evaluation of congenital heart disease by magnetic resonance imaging.

Magnetic resonance imaging (MRI) has evolved sufficiently to be recognized as a useful complementary noninvasive method to echocardiography in the evaluation of congenital heart disease (CHD). In some cases, MRI is superior to other imaging modalities, particularly in the evaluation of thoracic aortic anomalies and in defining the anatomy of central pulmonary arteries; it is also the procedure of choice in the postoperative follow-up of patients with CHD. Recent technological advances permit not only morphological evaluation (provided by spin-echo and MR angiographic techniques) but functional and flow information (provided by fast cine-GE and velocity-encoded sequences), causing it to be recognized by pediatric cardiologists and cardiac surgeons as an unavoidable technique for pre- and postoperative evaluation of some CHD. This review describes the various techniques used in the evaluation of CHD with emphasis on recent developments as well as recognized clinical applications. J. Magn. Reson. Imaging 1999;10:639-655.

Magnetic resonance imaging of the aorta and branch vessels.

Magnetic resonance imaging (MRI) can provide a comprehensive evaluation of the aorta and its major branches. T1-weighted spin-echo images and cine-MRI have long been known to be useful for the evaluation of congenital aortic anomalies, aortic aneurysms, and aortic dissections. Gadolinium (Gd)-enhanced three-dimensional magnetic resonance angiography (MRA) is a more recent development that affords better spatial resolution. This technique can be performed during an individual breath-hold and does not require electrocardiographic gating. The data from Gd-enhanced three-dimensional MRA, furthermore, can be used both for projectional angiographic viewing and for multiplanar reformation. In this article, MRI of the aorta and its major branches will be reviewed, with emphasis on the newer technique of Gd-enhanced three-dimensional MRA.

A serpentine and hypoplastic infrarenal aorta associated with aneurysm: A case report

Few congenital anomalies of the abdominal aorta have been well described in the literature. Coarctation of the abdominal portion of the aorta is a relatively rare occurrence that accounts for less than 2% of all aortic coarctations.1 Although some studies use the term hypoplasia interchangeably with coarctation, a distinct hypoplastic aortic syndrome also has been described. These patients are generally women who smoke, who are aged 30 to 45 years, and who have small distal aortas in conjunction with atherosclerotic disease.2 Hypoplasia of the aorta usually is associated with occlusive disease but not commonly with other aortic abnormalities. In this report, we describe the case of a 62-year-old man with an unusual aortic anomaly that we believe to be congenital in origin: a serpentine and hypoplastic infrarenal aorta found in conjunction with an abdominal aortic aneurysm. CASE REPORT A 62-year-old man with an infrarenal abdominal aortic aneurysm was referred to our facility after an interval increase in size of the aneurysm to 5 cm. His medical history was remarkable for poorly controlled hypertension. He had no significant surgical history. Medications included amlodipine besylate, atenolol, and buspirone hydrochloride. The patient had a 60 pack-year smoking history.

Spiral CT angiography of the thoracic aorta.

Computed tomographic (CT) angiography is a new minimally invasive vascular imaging modality. FOr its clinical use to increase, the advantages and potential applications of this modality must be understood. The clinical applications of CT angiography in the thoracic aorta and its branches include evaluation of congenital aortic anomalies, aortic aneurysm, aortic dissection, Takayasu arteritis, penetrating aortic atherosclerotic ulcer, traumatic aortic injury, the postoperative aorta, arch vessels, and pulmonary sequestration. The advantages of CT angiography over conventional angiography are as follows: (a) high-quality, thin axial sections that demonstrate mural changes, extraluminal pathologic conditions, and spatial relationships with adjacent organs; (b) high contrast resolution and high sensitivity for detecting calcified lesions; (c) angiographic or three-dimensional display of vascular structures and adjacent organs in any projection with a single spiral acquisition; and (d) demonstration of extrinsic causes of vascular compromise. CT angiography has the potential to replace conventional catheter angiography in the diagnosis of many pathologic conditions of the thoracic aorta.

New morphologic approach to the classification of anomalies of the aortic arch

The purpose of this article is to simplify the description of congenital anomalies of the aortic arch by developing a new classification system. Nine selected cases were retrospectively analyzed with the current classification and the new classification. We found that single anomalies of position or caliber were easy to classify. When complex anomalies were present classification was difficult, because only one aspect of the anomaly gives undue emphasis to that feature. We conclude that a system that details each anomaly on the basis of its abnormality of position and caliber, with reference to the normal situation, is an improvement. This new classification includes all of the potential aortic anomalies and facilitates their analysis. It appears to be a logical system that recognizes that congenital aortic malformations are a continuous spectrum from those anomalies purely of position to those purely of caliber.

Acute aortic dissection: typical and atypical imaging features.

Acute aortic dissection (AAD) is the most common emergency affecting the aorta. Noninvasive imaging allows prompt and reliable diagnosis of AAD and has largely supplanted aortography. However, atypical imaging features and diagnostic pitfalls can delay lifesaving therapy. An intimal flap is the characteristic feature of AAD. If there is flow within both lumina, typical imaging features are probably present. If the false lumen is thrombosed or there is no intimal tear to permit flow through the false lumen, a distinct intimal flap may not be present. Secondary signs of AAD include an intramural or periaortic acute thrombus, which manifests as a high-attenuation cuff or crescent on unenhanced computed tomographic scans. Other conditions that can reduce the conspicuity of the intimal flap include atypical configurations of the flap, such as seen with short dissections or with multiple false channels, in which case the flaps are complex. Finally, aortic anomalies may cause confusion.

Abnormal histology of the aortic arch in coarctation of the aorta

SummaryWe examined the number of elastic lamellae in the wall of the proximal aortic arch, aortic isthmus and descending aorta in patients with coarctation of the aorta. In the proximal aortic arch, the number of elastic lamellae was significantly lower in patients with coarctation compared to those with normal hearts without aortic anomalies and those with intracardiac defects but without aortic anomalies. The isthmus also showed a significantly lower number of elastic lamellae in the presence of preductal coarctation. In the descending aorta, the number of elastic lamellae was not significantly different between the different groups. There is doubt about the etiology of coarctation. Recent investigations showed that cells from the cardiac neural crest contribute to the formation of the arch arteries and the media of the arch. A developmental error of the neural crest might be responsible for the abnormal mural structures found in patients with aortic coarctation.

Magnetic resonance imaging of the pediatric thoracic aorta

Magnetic resonance imaging (MRI) is an ideal imaging modality for investigating anomalies of the pediatric thoracic aorta. Its multiplanar capabilities allow imaging along anatomic or perpendicular planes, and clearly show the relationship between the great vessels and the airway structures. The most common pediatric aortic lesions investigated by MRI include vascular rings and coarctation of the descending aorta and its surgical complications. Other obstructive, aneurysmal, and positional anomalies of the aorta are readily demonstrated and quantified. However, precise image prescription is necessary to obtain optimal information. This review discusses and illustrates the common pediatric anomalies and current appropriate choices of imaging techniques.