Case Of Double Aortic Arch Research Articles

Prenatal double aortic arch presenting with a right aortic arch and an anomalous artery arising from the ascending aorta

Double aortic arch is a rare anomaly of the aortic arch and this may cause tracheal damage by compressing the trachea during the first year of life. We report here on three fetal cases of double aortic arch and their outcomes. These malformations presented as an isolated right aortic arch or as a typical vascular ring form on the prenatal echocardiography that was obtained between 22 and 24 weeks gestation. In two of the three patients, the major intracardiac anomaly was a ventricular septal defect, and this was associated with the aortic malformation. A more detailed evaluation of the branching pattern of the aorta, and particularly whether the aorta gives off a left-sided limb of the double arch, could suggest the diagnosis of a double aortic arch in utero. Two patients underwent successful surgical correction and they showed good clinical outcomes. Fetal double aortic arch can be prenatally suspected after performing fetal echocardiography for those fetuses that show a right side aortic arch, and this can help to avoid delaying the postnatal management of this rare anomaly.

P03.03: Three cases of double aortic arch diagnosed in fetal period

P03.03: Three cases of double aortic arch diagnosed in fetal period

D-transposition of the great arteries and double aortic arch

Fig. 1. Volume-rendered image from CT (Somatom Sensation 16; Siemens Medical Solutions, Forchheim, Germany) demonstrates double aortic arch with dominant left arch. The aorta originates from the right ventricle. Only six cases of double aortic arch associated with D-transposition of the great arteries have been previously reported. RV: right ventricle, AA: ascending aorta, LSA: left subclavian artery, LCCA: left common carotid artery, RSA: right subclavian artery, RCCA: right common carotid artery.

Double aortic arches, esophageal atresia and tracheal compression

We report a case of double aortic arch in a 12-month-old male infant well delineated on 64 slice computed tomography scan. It formed a complete vascular ring around the trachea compressing it. The symptoms resolved after surgical division of the ring.

Prenatal Diagnosis and Outcome of Isolated Vascular Rings

The purpose of this study was to describe our experience in the ultrasound visualization and management of prenatally diagnosed isolated vascular rings. From January 2002 to December 2007, a total of 19 fetuses had a sonographic diagnosis of isolated vascular rings in 2 reference centers at a mean gestational age of 23 weeks. There were 8 cases of left aortic arch with aberrant right subclavian artery, 5 cases of double aortic arch, and 6 cases of right aortic arch with aberrant left subclavian artery. Two fetuses had associated trisomy 21 and 1 had a 22q11 microdeletion. Parents chose to terminate the pregnancy in all cases. Four patients successfully underwent surgical correction, and in 1 patient, tracheoplasty was also performed. In conclusion, isolated vascular rings can be accurately diagnosed prenatally by using the "3-vessel and trachea view" and "supra-aortic-branch view" that allow detection of vascular structures running around the trachea. Karyotyping and prenatal testing for 22q11 microdeletions should be offered to all parents. Affected children should undergo surgical correction as soon as symptoms of tracheal compression appear, avoiding tracheomalacia. Associated congenital tracheal stenosis should be excluded before surgery.

Double aortic arch and nasogastric tubes: A fatal combination

Double aortic arch is a common form of complete vascular ring that encircles both the trachea and the esophagus, and presents with various respiratory and esophageal symptoms, usually in the pediatric population. We present a case of double aortic arch in an adult patient that manifested as massive upper gastrointestinal bleeding after prolonged nasogastric intubation.

Prenatal Tracheal Obstruction Due to Double Aortic Arch: A Potential Mimic of Congenital High Airway Obstruction Syndrome

WEB This is a Web exclusive article. ouble aortic arch is a relatively common congenital anomaly of the aortic arch system resulting from failed regression of the fourth pharyngeal arch arteries. Symptoms develop postnatally due to compression of the trachea and esophagus, which are encircled by the left and right aortic arches. The classic history is noisy breathing during the first few weeks of life, and the diagnosis is usually confirmed by postnatal echocardiography or MRI. Prenatal diagnosis is rare [1, 2], and double aortic arch has not been previously described as a cause of prenatal tracheal obstruction, to our knowledge. Congenital high airway obstruction syndrome (CHAOS) is a recognized cause of prenatal central airway obstruction due to intrinsic atresia or stenosis of the larynx or upper trachea. CHAOS causes pulmonary overdistention due to retained bronchial secretions. Increased intrathoracic pressure with impaired venous return is believed to account for the associated development of fetal hydrops. The resulting constellation of large echogenic lungs with flattening or inversion of the diaphragm, dilated fluid-filled airways below the level of obstruction, and fetal hydrops or ascites is considered characteristic of CHAOS on prenatal sonography. Untreated CHAOS inevitably leads to fetal demise or stillbirth [3–5]. We present a case of double aortic arch that caused prenatal central airway obstruction and that mimicked CHAOS on fetal echocardiography and MRI.

Successful surgical treatment for an adult case of double aortic arch

We present the case of a 39-year-old male who had complaints of dysphagia and throat pain. Computed tomography (CT), 3 dimensional CT and aortography revealed a double aortic arch (Edwards type IA). The patient underwent exploration through a left-sided thoracotomy and the left arch was divided at the distal site of the left subclavian artery, which completely relieved the esophageal compression.

Sixteen-row multislice computed tomography in infants with double aortic arch

Background: The introduction of multislice computed tomography (MSCT) in 1998 has led to a considerable boost of CT angiography. Four-row MSCT has been employed in the diagnostic assessment of vascular rings. Sixteen-row MSCT is expected to further increase the diagnostic power of MSCT. We report three cases of double aortic arch diagnosed by a 16-row MSCT, and discuss the possible advantages of this diagnostic tool. Patients and Methods: From April 1, 2003, to September 1, 2003, three patients underwent 16-row MSCT at our institution to evaluate the possible presence of a vascular ring. All patients presented with stridor and feeding difficulties. MSCT was performed under bland sedation (chloral hydrate 60 mg/kg). ECG gating and breath hold were not employed. Three-dimensional reconstructions were employed to assess the presence of airway compromise as well as of vascular anomalies. Results: Scanning time averaged 4 s (3.8–4.5 s). Motion artefacts were not relevant. The CT scan showed the existence of a vascular anomaly as well as of a significant tracheal compression in all cases, and was considered conclusively diagnostic by the cardiac surgeons. All three patients underwent uncomplicated corrective surgery without further investigations. Conclusion: Sixteen-row MSCT with 3D reconstruction allows a precise evaluation of the airway compromise and a detailed assessment of the anatomy of vascular anomalies. The very short scanning time allows to avoid deep sedation and anaesthesia, and to obtain higher image quality and spatial resolution, with a concomitant reduction of the radiation dose.

Historical control data on reproductive abilities and incidences of spontaneous fetal malformations in Wistar Hannover GALAS rats.

Wistar Hannover rats, which have recently been introduced into Japan, are expected to be used in reproductive and developmental toxicity studies, yet the accumulation of background data is insufficient. This paper describes our historical data on the reproductive ability of this strain of rat. Three lots of sexually matured females (40 each) were received from CLEA JAPAN, Inc. with males of the same strain (30 or 36 each) and mated. A total of 47 dams were killed on gestation day 20 to examine their fetuses. The remaining 71 pregnant females were allowed to deliver spontaneously and observed for common reproductive parameters. The mating and fertility indices of females were both 99.2%. Overall mean numbers of implants and live fetuses at cesarean sectioning were 12.5 and 11.5, respectively. Fetal resorptions and deaths occurred at an incidence of 8.6%. Morphological examinations of fetuses revealed low incidences of spontaneous malformations (each one case of double aortic arch and absent cervical vertebral arch) and a variety of common variations. The followings are overall means of major reproductive parameters obtained from females with live birth: no. of implants, 12.5; no. of pups delivered, 11.8; viability index of pups at birth, 99.8%; and days of age at sexual maturation (vaginal opening and preputial separation), 30.3 and 42.8, respectively. Our present observations confirmed a minimal deviation among 3 lots of animals in terms of reproductive abilities. These results suggest that this strain of rat can be used in reproductive and developmental toxicity studies, although the sensitivity to toxicants remains to be elucidated.

Repair of double aortic arch associated with D-transposition of the great arteries

D-Transposition of the great arteries is infrequently associated with anomalies of the aortic arch. We report a rare case of double aortic arch associated with D-transposition of the great arteries. The diagnosis was made by angiography and transthoracic echocardiography. The patient underwent a successful simultaneous arterial switch operation and division of the vascular ring through a median sternotomy incision.

Rare case of double aortic arch with hypoplastic right dorsal segment and associated tetralogy of Fallot: MR findings

We report a rare case of double aortic arch with a hypoplastic right dorsal arch segment, which was also associated with tetralogy of Fallot. Accurate characterization of the hypoplastic right arch segment by MRI preoperatively determined the optimal surgical approach to releasing the symptomatic vascular ring. MRI was also useful in assessing and monitoring associated tracheomalacia.

Double Aortic Arch Associated with Coarctation of Both Limbs: A Case Report

A case of double aortic arch with coarctation of both limbs is described. The patient, a thirteen-year-old girl, demonstrated only the symptoms of coarctation and had no intracardiac anomalies. Discrete coarctation of bilateral limbs distal to the subclavian artery was shown by aortography. Although either double aortic arch or coarctation of the aorta is not so rare, the combination of these two anomalies is quite unusual. This is the third case in the world literature.

An adult case of double aortic arch

An adult case of double aortic arch

重複大動脈弓の4例

重複大動脈弓の4例

Right aortic arch. Types and associated cardiac anomalies.

An analysis was made of 78 pathologic specimens in which a right aortic arch was present. In four, the right arch was part of a double aortic arch. In 74 cases the right aortic arch was the only arch. The cases of right aortic arch could be subdivided into two groups as follows: (1) that with a retroesophageal aortic segment (three cases) and (2) that without a retroesophageal segment (71 cases). The latter cases could be subdivided according to the nature of the origin of the branches of the arch as follows: (1) mirror image branching (60 cases), (2) aberrant left subclavian artery (ten cases) and (3) isolation of left subelavian artery (one case). Congenital heart disease, of which the tetralogy of Fallot was the most common, was observed in each of the cases of right arch without retroesophageal aortic segment. Such an association was seen in one of three cases of right aortic arch with retroesophageal aortic segment and in three of the four cases of double aortic arch. The potential for significant tracheal and esophageal obstruction is present in double aortic arch, in right aortic arch with retroesophageal segment and in right aortic arch without retroesophageal segment but with an aberrant left subelavian artery. In the latter condition, significant esophageal and tracheal compression depends upon the presence of a left-sided ductus arteriosus. This state was observed in five of ten cases with right aortic arch and aberrant left subelavian artery.

Surgical treatment of vascular ring.

Seven patients with vascular ring have been operated upon since 1965 at the Keio University Hospital with one operative death and three late deaths. Four patients had double aortic arch and 3 had right aortic arch with left ductus arteriosus. The lesser arch was divided in the four cases of double aortic arch. Ductus or ligamentum was divided in the three cases of right aortic arch with left ductus arteriosus or ligamentum arteriosum. Respiratory distress seems to constitute major cause of post-operative death and complete relief from respiratory and swallowing difficulties was achieved in only two out of the seven cases.

A Case of Double Aortic Arch with Atrial Septal Defect and Left Superior Vena Cava

A Case of Double Aortic Arch with Atrial Septal Defect and Left Superior Vena Cava

Angiocardiographic study of a case of double aortic arch without symptoms

A case of a complete double aortic arch is presented. The patient had no symptoms or signs referable to the anomaly. Attention is called to the importance of angiocardiography in the differential diagnosis of mediastinal masses and for clear delineation of a double aortic arch.

A rare case of double aortic arch with concurrent transposition of the stomach and developmental defects of the spinal column.

A case of double aortic arch and double descending aorta incidently detected on mass chest radiology and verified rontgenographically is reported. The patient was a woman who had never had and was not presenting clinical evidence of cardiac disease. The examination also revealed transposition of the stomach and developmental defects of the spinal column.