Case Of Double Aortic Arch Research Articles

Demonstration of Double Aortic Arch in a 21 Weeks Primigravida by Color Spatiotemporal Image Correlation Rendering Technique

AbstractFetal double aortic arch (DAA) is a rare congenital arch anomaly characterized by the presence of two aortic arches instead of the normal single arch. DAA is an uncommon finding during routine fetal echocardiography.Prenatal ultrasound detection of fetal DAA is crucial for early identification and appropriate management of affected fetuses. Despite the challenges and limitations, advancements in imaging technology and expertise have improved diagnostic accuracy.Four-dimensional (4D) ultrasound provides a volumetric representation of the fetal structures. It allows for better visualization and assessment of complex anatomical abnormalities, including DAA. With 4D imaging, the sonographer can manipulate the image, rotate it, and view it from different angles, aiding in the identification of the double arch anomalyThis is a case of double aortic arch diagnosed with the spatiotemporal image correlation (STIC) technique of 4D ultrasound using color Doppler.

A case of double aortic arch with tracheal stenosis and its anaesthetic management.

A case of double aortic arch with tracheal stenosis and its anaesthetic management.

A Rare Cause of Respiratory Distress in Infants: Double Aortic Arch

Vascular ring, which is a rare cause of respiratory distress in infants, results in respiratory and gastrointestinal findings due to tracheal and/or esophageal compression, but the diagnosis may be delayed because of the nonspecific symptoms. Double aortic arch is the most common vascular ring anomaly. A case of double aortic arch presented with respiratory distress, stridor, and feeding intolerance during infancy is discussed.

EP10.07: Two cases of double aortic arch diagnosed in fetal period

EP10.07: Two cases of double aortic arch diagnosed in fetal period

Prenatal echocardiographic diagnosis of right aortic arch and its branch type

Objective To investigate the value of prenatal echocardiographic diagnosis of anomalies of the right aortic arch(RAA) and its branch type, and provide rapid diagnostic methods. Methods A retrospective analysis of 55 cases of RAA of prenatal ultrasound diagnosis results, and their imaging characteristics were summarized. Results There were 55 cases of anomalies of the RAA, included 42 cases of RAA with aberrant left subclavian artery(RAA-ALSA) and 13 cases of RAA with mirror image branching pattern(RAA-MB), 1 case of double aortic arch(DAA) was misdiagnosed as RAA. The prenatal echocardiographic characteristics of RAA-ALSA: in three-vessel-aortic arch view, the first branch of the aortic arch was the left carotid artery, which ran in front of the trachea, and ALSA ran behind the trachea and esophagus. The prenatal echocardiographic characteristics of RAA-MB: the first branch of the aortic arch was the brachiocephalic trunk, which ran in front of the trachea and was divided to the left carotid artery and the left subclavian artery. Conclusions Prenatal ultrasound can qunickly and accurately diagnose anomalies of the right aortic arch and its branch type according to the direction, thickness and secondary branches of the first branch of the aortic arch. The location of arterial duct is helpful to judge the formation of vascular ring. Key words: Ultrasonography, prenatal; Right aortic arch; Vascular ring

Strategies for Accurate Diagnosis of Fetal Aortic Arch Anomalies: Benefits of Three-Dimensional Sonography With Spatiotemporal Image Correlation and a Novel Algorithm for Volume Analysis

Obtaining an accurate diagnosis of fetal aortic arch anomalies is often difficult with traditional two-dimensional (2D) sonography. Thus, the aim of this study was to assess the value of three-dimensional (3D) sonography with spatiotemporal image correlation for diagnosing fetal aortic arch anomalies using a novel algorithm for 3D volume analysis. Two-dimensional and 3D echocardiographic image data from 300 normal fetuses and 30 fetuses with aortic arch anomalies were retrospectively reviewed. Grayscale and high-definition flow imaging data were available for 2D echocardiography. Three-dimensional volumes were acquired in parasagittal views with high-definition flow imaging information. Volume postprocessing was performed using a novel algorithm to obtain 3D tomographic ultrasound imaging slices and color-rendered images. Detection of aortic arch positions, aberrant brachiocephalic patterns, and aortic arch anomalies was compared for 2D and 3D modalities. Postnatal echocardiography was used as the truth standard in assessing aortic anatomy. In total, four cases of double aortic arch, 21 cases of right aortic arch, one case of retroesophageal aortic arch, and four cases of left aortic arch with aberrant right subclavian arteries were included. Inter- and intraobserver agreement were excellent for 2D and 3D modalities. The 3D modality offered better sensitivity and accuracy compared with 2D imaging for the detection of brachiocephalic anomalies (P<.01) and arch anomalies (P<.01) but comparable sensitivity for arch position. There was no difference in specificity for both modalities. The proposed novel algorithm for volume postprocessing ensures that 3D reconstructed images are obtained with high repeatability. The addition of 3D spatiotemporal image correlation to fetal echocardiography may offer a more accurate diagnosis for arch anomalies.

Fetal aortic arch and its branches anomalies: prenatal ultrasound, vascular cast and gene detection

Objective To explore the application values of prenatal ultrasound, vascular cast in the diagnosis of fetal aortic arch and its branches anomalies and to analyze the genetic characteristics by gene detection. Methods Twenty-two cases of the vascular cast specimens of the fetal aortic arch and its branches anomalies were analyzed and studied by comparing with their prenatal ultrasonography. Then the characteristics of each type of fetal aortic arch and its branches anomalies, the missed diagnosis and misdiagnosis were summarized and the results of their gene detection were also analyzed. Results The 22 cases of fetal aortic arch and its branches anomalies were as follows: 2 cases of double aortic arch showed the ascending aorta was divided into two branches after converging as the descending aorta. Three cases were left aortic arch with aberrant right subclavian artery. Twelve cases were right aortic arch: 8 cases were right aortic arch with mirror-image branching, 3 cases were right aortic arch with aberrant left subclavian artery, 1 case was right aortic arch with isolated left subclavian artery. Of the 8 right aortic arch with mirror-image branching, 3 cases of left arterial duct showed the vertical walking between the fusion site of the left innominate artery and the pulmonary artery. Right aortic arch with aberrant left subclavian artery with arterial duct showed U shaped vascular ring. Five cases were other types, including 2 cases of the coarctation of aortic arch, 1 case of interrupted aortic arch, 1 case of pulmonary artery sling, and 1 case of abnormal origin of right pulmonary artery. The ultrasonic missed diagnosis were the 6 deformities: 3 cases of arterial duct and 3 cases of aberrant subclavian artery. The ultrasonic misdiagnosis were the 5 deformities: 2 cases of arterial duct location, 1 case of aberrant subclavian artery, 1 case of isolated left subclavian artery, and 1 case of the coarctation of aortic arch. Genetic test results: In the 18 cases of the genetic detection, 2 cases were positive, 1 case was 22q11.2 microdeletion syndrome and 1 case was carrying KMT2D gene variant. Conclusions There are various kinds of fetal aortic arch and its branches anomalies, which are often associated with intracardiac malformations and venous branches variation. And prenatal ultrasound is of great value in diagnosing them.Vascular cast can visually display their characteristic changes, which is helpful to improve the differential diagnosis of the different aortic arch and its branches anomalies. The detailed genetic detection can improve the further understanding of its etiology. Key words: Ultrasonography, prenatal; Fetus; Aortic arch anomalies; Vascular cast; Gene detection

EP04.15: Postnatal clinical course of the fetal vascular ring

The prenatal diagnosis of the vascular ring increases. However, the postnatal course of the vascular ring is not clear. Aim of this study is to clarify the postnatal course of the vascular ring. We reviewed the clinical record of 20 cases of vascular ring that were diagnosed in fetal echocardiography. Of these, double aortic arch were 3 cases, right aortic arch and left subclavian origin abnormality were 17 cases. All cases of double aortic arch were performed surgery in order to developing respiratory or digestive symptoms in their infancy. The operation were performed in 3 cases of right aortic arch and left subclavian origin abnormality. 2 cases of them get operated after their 1 year old, while a case got in infancy. There were no symptoms in remaining 14 cases at their 1 year old. There was not the case of the emergency that required respiratory care just after birth in this examination. Then patients of double aortic arch might need careful follow up and early operation from their neonatal period. Patients of right aortic arch and left subclavian origin abnormality have usually asymptomatic clinical course. Then they might not need operation in neonatal. Patients of right aortic arch and left subclavian origin abnormality should be observed carefully for their symptoms developing, and be examined surgical indication.

Prenatal imaging diagnosis and prognosis assessment of vascular ring

Objective By comparing the results of prenatal diagnosis of vascular rings by ultrasound and MRI, chromosome screening and postnatal follow-ups, to explore the clinical significance of prenatal diagnostic technology for the diagnosis of vascular rings and prognostic assessment. Methods Ninety-five fetuses that were diagnosed by fetal echocardiography were followed up regularly, of which 72 cases had chromosome screening, 31 cases had MRI examination. These results were compared with the postnatal follow-up outcome. Results Ninety-five cases of vascular rings included 85 cases of right aortic arch(RAA) and left ductus arteriosus(LDA), 4 cases of pulmonary artery sling(LPAS), 4 cases of double aortic arch(DAA), 1 case of RAA and double ductus arteriosus(DDA), 1 case of left aortic arch(LAA) and aberrant right subclavian artery(ARSA). Sixty-six cases of isolated vascular rings and 29 cases of complex vascular rings(combined with other cardiovascular abnormalities) were detecded. Fifty-four cases were born(2 infants died), 8 cases were ongoing pregnancy, 6 cases were lost to follow-up, 27 cases were aborted. Prenatal ultrasound and MRI examination indicated 6 cases of trachea compression. However, only 3 infants showed clinical symptoms due to trachea compression from born 5 cases. Conclusions Isolated vascular ring is the most common format and its diagnosis and type can be determined by prenatal ultrasound. Dynamic follow-up using ultrasound in pregnancy combined with MRI is helpful to assess the compression degree of trachea induced by vascular ring and prognosis. Key words: Ultrasonography, prenatal; Magnetic resonance imaging; Fetal heart; Vascular ring

Assessment of congenital vascular rings with MDCT on children

To evaluate the value of MDCT on diagnosis of congenital vascular rings on children. Retrospective analysis on 43 cases of congenital vascular rings, which underwent MDCT during Oct 2008 to Dec 2014 in Beijing Anzhen hospital affiliated to capital medical university. 21 males, 22 females; age from 29 days to 8 years, mean age 1.46 years, 33 cases are not beyond 1 year. All the results were compared with that of the echocardiogram or record of the surgery. The CT data were read and reconstructed with multiplanar reconstruction (MPR), maximum intensity projection (MPR), minimum intensity projection (MinIP), volume rendering (VR). The image quality was evaluated and the diagnostic value and the standard diagnostic program were discussed. Of 43 cases of vascular rings:there were 6 cases of pulmonary artery sling (13.95%), 9 cases of right aortic arch /aberrant left subclavian artery(20.93%), 18 cases of left aortic arch/aberrant right subclavian artery (41.86%), 10 cases of double aortic arch (23.26%). Forty cases (93.02%) were combined with other cardiovascular or pulmonary malformations. Every malformation was revealed clearly and proved by echocardiogram. Of 3 cases (6.98%) without any other malformation, 2 cases were combined tracheal stenosis. A pulmonary artery sling was proved by surgery; the other 2 cases were double aortic arch. All the images of 43 cases could be reconstructed well. MPR and VR showed the origin, shape, and whole course of vascular rings directly; MinIP and VR could display the shape, width and development of trachea, revealed the relationship between vascular rings, trachea and esophagus. It was important to show and measure the component vascular of the ring. Attention should be paid to the whole course of trachea and esophagus, especially those segments which were close to the ring vascular. The tracheal stenosis as well as intra-cardio anatomy malformations should be measured on MPR images if existed. According to the segmental analysis method, comes the overall final diagnosis. A standard diagnostic program on vascular ring was proposed. MDCT axis images with various 3D post processing methods could reveal the compose of vascular rings and the relationship between vascular rings, trachea and esophagus.

Value of combination of three-vessel views in ultrasound diagnosis of fetal aortic arch and pulmonary arterial branch anomalies

Objective To evaluate the role of combination of three-vessel views in ultrasound diagnosis of fetal aortic arch and pulmonary arterial branch anomalies. Methods The data of 66 cases of fetal aortic arch and pulmonary arterial branch anomalies were retrospectively analysed, including echocardiographic data, autopsy and operation records and postnatal follow-up results. Echocardiogaphic features and display frequencies on three vessels and trachea view(3VT), three vessels view(3VV) and three vessels and pulmonary arterial branches view(3VP) were summarized. Results There were 52 cases of aortic arch abnormalities, including 32 cases of right aortic arch with left ductus arteriosus, 4 cases of double aortic arch, 7 cases of aberrant right subclavian artery, 6 cases of coarctation of aorta and 3 cases of interruption of aortic arch. Fourteen cases were diagnosed pulmonary aterial branch abnormalities, including 10 cases of crossed pulmonary arteries, 2 cases of anomalous origin of left pulmonary artery from aortic arch and 2 cases of pulmonary artery sling. The display frequencies of fetal aortic arch and pulmonary arterial branch anomalies on 3VT, 3VV and 3VP were 80.3%, 19.7% and 39.4%. Conclusions The combination of three-vessel views is of great value in prenatal diagnosis of fetal aortic arch and pulmonary arterial branch anomalies. Key words: Ultrasonography, prenatal; Heart defects, congenital; Three-vessel view; Aortic arch; Pulmonary arterial branch

A rare case of double aortic arch suspected by preoperative chest X-ray in a healthy woman

A rare case of double aortic arch suspected by preoperative chest X-ray in a healthy woman

An Adult Case of Double Aortic Arch

An Adult Case of Double Aortic Arch

Double aortic arch: postnatal obliteration of the left aortic arch. Is arterial duct closure responsible?

We present a case of double aortic arch with a predominant right and a double arterial duct detected by echocardiogram in a 28-week gestation foetus. The first evaluation revealed that both arches were perfused; the 1-month postnatal echocardiogram showed the closure of both arterial ducts and the partial obliteration of the left aortic arch between the left subclavian artery and the dorsal aorta. In our case, the postnatal obliteration of the left arch in a double aortic arch was probably due to the closure of the left-sided arterial duct.

Complete vascular ring leading to long-term tracheal compression in a young adult

Vascular ring is usually an isolated anomaly of embryonic development leading to compression of the encircled trachea and/or esophagus. Double aortic arch is the most commonly encountered form of vascular ring. Vascular rings may either be symptomatic shortly after birth or less commonly, they may persist with mild symptoms until they are diagnosed later in life. In this report, we present a case of double aortic arch forming a complete VR and tracheal compression in a young adult with long term respiratory symptoms. 14 years old female patient had been followed up with recurrent respiratory tract infections since her infancy period. The patient was evaluated by computed tomography and a complete vascular ring due to double aortic arch was demonstrated. The patient was operated; right arcus aorta was divided and tracheal compression was released. Postoperative period was uneventful and symptoms of tracheal compression were dramatically reduced in intensity. Vascular rings must be considered in patients with recurrent respiratory symptoms, since early diagnosis and treatment are important to prevent the long term sequelae of tracheobronchial compres- sion.

Double aortic arch: an unusual congenital variation

Double aortic arch is a rare variation of the aortic arch that may cause tracheal and esophageal compression. Two postnatal cases of double aortic arch and their outcomes are reported. Both patients presented with stridor, repeated respiratory infections and episodes of apnea. Computerized tomography angiographic three-dimensional reconstruction revealed that in both patients, the right common carotid artery and right subclavian artery had separate origins from the right loop of the double aortic arch. The left subclavian artery and left common carotid artery arose separately from the left aortic arch. Both patients underwent corrective surgery and made an uneventful recovery.

The diagnostic value of MSCT multi-dimensional reconstructions for congenital vascular ring with tracheal stenosis

To evaluate the diagnostic value of multi-slice CT (MSCT) reconstructions for congenital vascular rings together with tracheal stenosis. 9 cases of children with congenital vascular ring and tracheal stenosis confirmed by surgery were collected in the study, all cases had undergone thin slice CT contrast enhancement, the MSCT data were transmitted to the workstation for multiplanar reconstruction (MPR), volume rendering technique (VRT) and VR transparency reconstruction. With the surgical results as the gold standard, the imaging characteristics of echocardiography (UCG) and MSCT were comparatively analyzed. In 9 cases, there were 4 cases of pulmonary artery sling, 3 cases of right aortic arch combination with left aberrant subclavian artery, 1 case of double aortic arch, 1 case of innominate artery compression syndrome. In this group, 5 cases were accompanied with other cardiac malformations (tetralogy of Fallot in 2 cases, double outlet right ventricle with patent ductus arteriosus and ventricular septal defect in 1 case, ventricular septal defect in 1 case, double superior vena cava in 1 case), 1 case of tetralogy of Fallot demonstrated many tortuous collateral arteries around aorta. All malformations were well displayed by VRT, MPR. VR transparency reconstruction can stereoscopically display trachea and bronchial compression condition, the main trachea was compressed in 6 cases, the main trachea and left main bronchus was compressed in 2 cases, the main trachea and left main bronchus was compressed in 1 cases, UCG detected all intracardiac malformations, 1 case of pulmonary artery sling was misdiagnosed as patent ductus arteriosus, 8 cases of vascular rings, tracheal and bronchial stenosis were missed. MSCT reconstruction technology is a noninvasive, rapid diagnostic method, it can clearly show the congenital vascular rings abnormalities and the degree of tracheal stenosis, it has important significance for clinic treatment.

Duplo arco aórtico: a quebra do silêncio

Anéis vasculares representam 1-2% dos casos das cardiopatias congênitas. Relatamos um caso raro de duplo arco aórtico. Mulher, 60 anos, procurou atendimento na clínica médica apresentando 1 ano de história de disfagia, 6 meses de dispneia e 2 meses de dor torácica esporádica. Raio X de tórax revelou: hiperinsuflação pulmonar difusa, alargamento mediastinal, coração com volume e configurações normais, arco aórtico à direita e alterações degenerativas vertebrais. Tomografia computadorizada do tórax: arco aórtico duplo circundando e comprimindo a traqueia e o esôfago. Arco direito mais calibroso, emergindo dele o tronco braquiocefálico. Do arco esquerdo emergem a artéria carótida comum e a subclávia esquerda. Diagnóstico: anel vascular traqueoesofagiano decorrente do duplo arco aórtico, sendo o arco direito dominante. No presente caso, optou-se por seguimento clínico da paciente, levando-se em conta a intensidade dos sintomas apresentados.

A case of double aortic arch accompanied by sub-aortic and pre-aortic left brachiocephalic veins and anomalous origin and course of left vertebral artery

During the elective course of human dissection at the University of Toyama in 2007, we encountered a rare case of double aortic arch accompanied by sub- and pre-aortic left brachiocephalic veins (LBV), and anomalous origin and course of the left vertebral artery in a Japanese elderly female. The double aortic arch formed a complete vascular ring that encircled the trachea and the esophagus. The sub-aortic LBV traversed below the aortic arches between the ascending aorta and the trachea. In addition, there was a small pre-aortic LBV passing anterior to the origins of the aortic arches. The left vertebral artery originated from the left aortic arch and entered the transverse foramen of C3, while the right vertebral artery originated from the right subclavian artery and entered the transverse foramen of C6.

A Rare Type of Double Aortic Arch Diagnosed by Echocardiography in an Asymptomatic 9-Year-Old Patient

A case of double aortic arch with an atretic left arch distal to the origin of the left subclavian artery was suspected by echocardiography (ECHO) in an asymptomatic 9-year-old girl and confirmed by magnetic resonance imaging (MRI). The authors report their ECHO findings, which could be an important diagnostic tool for symptomatic patients because confusion exists in the literature regarding the differentiation of the aforementioned rare malformation from a right arch with mirror image branching. The authors support their ECHO proposal with an explanation based on the hypothetical double aortic arch plan set by Edwards.