Surgical Repair of Double Aortic Arch: 16-Year Experience

2005 ◽  
Vol 13 (1) ◽  
pp. 4-10 ◽  
Author(s):  
Ganesh Shanmugam ◽  
Kenneth Macarthur ◽  
James Pollock
Keyword(s):  
Aortic Arch ◽  
Surgical Repair ◽  
Surgical Complication ◽  
Vascular Ring ◽  
Symptomatic Relief ◽  
Median Sternotomy ◽  
High Risk Group ◽  
Double Aortic Arch ◽  
Long Term Results ◽  
Persistent Symptoms

Double aortic arch (DAA) is a complete form of vascular ring causing tracheoesophageal compression. We analyzed long-term results of a series of DAAs, over a period of 16 years. Between 1987 and 2003, 29 children underwent surgery for airway and/or esophageal compression secondary to a DAA. Dominant symptoms were stridor, dysphagia, choking episodes, and life-threatening apneic spells ( n = 7). Diagnosis was established by barium studies, bronchoscopy, echocardiogram, angiogram, computed tomography (CT), and magnetic resonance imaging (MRI). Seven patients had concurrent cardiac anomalies. Two children had an associated tracheoesophageal fistula. Surgery was accomplished by left thoracotomy ( n = 25), right thoracotomy ( n = 2) or median sternotomy ( n = 2). The operative mortality was zero. There was one late death due to respiratory failure. Four (13.8%) patients had a surgical complication (chylothorax, 3 cases; acute renal failure, 1 case). Follow-up (mean 7.1 years; range 6 months to 16 years) was complete in all patients, and showed complete improvement in 22 patients and partial improvement in 6 patients. Early surgical repair of DAA is associated with low mortality, and results in marked symptomatic relief in most patients. Patients with tracheomalacia or associated asthma, constitute a high-risk group and may manifest persistent symptoms and require adjunctive procedures.

Adult Aortotracheal Fistula as Sequela of Double Aortic Arch Repair in Infancy: A Case Report

2020 ◽  
Vol 129 (7) ◽  
pp. 649-652
Author(s):  
Andrew B. Rees ◽  
Jennifer P. Rodney ◽  
Mark R. Gilbert ◽  
Clayton A. Kaiser ◽  
Alexander H. Gelbard
Keyword(s):  
Aortic Arch ◽  
Digeorge Syndrome ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Vascular Ring ◽  
Clinical History ◽  
Double Aortic Arch ◽  
Aortic Arch Repair ◽  
Early Surgical Intervention

Introduction: Double aortic arch is a rare congenital malformation of the aortic arch that most frequently presents in childhood. Early surgical intervention typically yields excellent outcomes. Objectives: To describe aortotracheal fistula as a rare, yet serious complication of vascular ring and subsequent aortic aneurysm in an adult patient. Methods: Clinical history, as well as radiographic and endoscopic imaging were obtained to describe the development, diagnosis, and clinical course of this patient’s aortotracheal fistula. Additionally, follow up data was obtained to document the healing of this fistula after surgical repair. Results: We describe a case of a 46-year-old male with DiGeorge Syndrome and a double aortic arch, repaired in childhood, which developed into an aortotracheal fistula after tracheostomy placement as an adult. Conclusions: This case demonstrates that dangerous complications of a double aortic arch can persist into adulthood, even after surgical repair in infancy. Each patient’s unique anatomy must be considered when thinking about airway management and prevention of complications of this rare congenital anomaly.

Vascular ring surgery – can we do better?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Amir ◽  
N Soffair ◽  
G Frenkel ◽  
E Bruckheimer ◽  
E Nachum ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Respiratory Symptoms ◽  
Ductus Arteriosus ◽  
Vascular Ring ◽  
Symptomatic Relief ◽  
Mirror Image ◽  
Vascular Rings ◽  
Number Of Patients ◽  
Age At Surgery

Abstract Background Vascular anomalies of the Aortic arch can cause respiratory symptoms in children due to tracheal compression. Treatment consists of division of the vascular rings, nevertheless data regarding mid- term results is scarce. The purpose of this study was to evaluate clinical results of vascular ring surgery. Methods Between2007–2014, 85 children underwent vascular ring surgery. 51 had Double Aortic Arch (DAA, 60%), 31 Right Arch with Aberrant Subclavian Artery (RAA & ALSA, 36.5%) and 3 had RAA, mirror image branching & left ductus arteriosus (3.5%). Mean age and weight at operation were 12.4±13months and 8.6±4.1 kg respectively. Mid-term follow-up included clinical follow up by a pulmonologist (38 patients, 44.7%) and a telephone questionnaire (71 patients, 83%) performed 57±25.7 months after surgery. Results In most patients, symptomatic relief occurred in less than 6 months (table 1). Mid –term follow up revealed that although most parents described a significant improvement in their child's respiratory symptoms (95%), a significant number of patients described some residual respiratory symptoms (table 2). We did not find any significant association between age at surgery (under 6 month), or vascular ring anatomy (DAA vs. RAA&ASA) and the presence of residual symptoms at follow up Conclusions Surgical division of vascular rings results in a significant clinical improvement within one year, nevertheless many patients remain symptomatic to some degree. We found no association between the age at surgery or anatomic variant to the presence of symptoms in mid- term follow up. Further evaluation whether a more aggressive surgical approach is warranted in order to decrease the incidence long-term symptoms. Funding Acknowledgement Type of funding source: None

Double aortic arch: an elusive diagnosis in a child with CHD

2021 ◽  
pp. 1-3
Author(s):  
Mariana Lemos ◽  
Miguel Fogaça da Mata ◽  
Ana Coutinho Santos
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Aortic Arch ◽  
Ct Angiography ◽  
Septal Defect ◽  
Vascular Ring ◽  
Pulmonary Atresia ◽  
Double Aortic Arch ◽  
Shunt Surgery

Abstract An 18-month-old male with pulmonary atresia and ventricular septal defect presented with stridor after neonatal systemic-to-pulmonary artery shunt surgery, that persisted on follow-up. CT angiography revealed a vascular ring with balanced double aortic arch.

scholarly journals Complete Vascular Ring Detected by Barium Esophagography

2002 ◽  
Vol 81 (8) ◽  
pp. 554-555 ◽  
Author(s):  
Liam J. Skinner ◽  
Stephanie Ryan ◽  
John D. Russell
Keyword(s):  
Aortic Arch ◽  
Vascular Ring ◽  
Double Aortic Arch ◽  
Vascular Rings ◽  
Barium Esophagography

The diagnosis of a vascular ring can be made on the basis of characteristic findings on barium esophagography. We report a case of a double aortic arch in a 9-month-old girl that was diagnosed in this manner, and we briefly review the anatomic characteristics of vascular rings.

scholarly journals P725 An unexpected direction: a case report of a double aortic arch in an asymptomatic woman in adulthood

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I Campos ◽  
C Vieira ◽  
N Salome ◽  
V H Pereira ◽  
A Costeira Pereira ◽  
...  
Keyword(s):  
Case Report ◽  
Aortic Arch ◽  
Ct Angiography ◽  
Vascular Ring ◽  
Double Aortic Arch ◽  
Posterior Arch ◽  
Vascular Rings ◽  
Thoracic Ct ◽  
Extrinsic Compression ◽  
The Right

Abstract Introduction Complete vascular rings represent about 0.5-2% of all congenital cardiovascular malformations, with the double aortic arch (DAA) being the most common of the complete vascular rings, causing tracheoesophageal compression. The right (posterior) arch is usually dominant (70%), although the two arches can have the same size (5%). The left (anterior) arch is dominant in only approximately 25% of cases. In most cases, this anomaly is diagnosed during childhood due to symptoms caused by oesophageal or tracheal compression. For this reason, case reports of adults are rare. This report describes a case of a 61-year-old woman with DAA with dominant left arch, diagnosed accidentallyby thoracic CT angiography. Case Report Description A 61 years old woman with a previous story of hypertension and type 1 diabetes presented to the emergency service with dyspnoea and thoracic pain. She also referred a history of intermittent dysphagia and cough with at least 12 years of progression. All the parameters of the physical examination were within normal limits. The electrocardiogram showed a normal sinus rhythm with no evidence of acute ischemia and her blood analyses did not show any abnormalitie. She also performed a thoracic CT angiography, which excluded signs of pulmonary embolism, but revealed a vascular ring suggesting a double aortic arch with permeability in both right and left arches as well as their collaterals. The Cardiac MRI was performed with the purpose of excluding ischemia, confirming the double aortic arch with left dominance. The right arch, posterior to the oesophagus and trachea, and the left arch, in an anterior position, showed an anatomic compression of the oesophagus as well as the proximal trachea, capable of eliciting the symptoms mentioned. Other congenital anomalies were excluded. The echocardiography did not demonstrate any additional cardiac malformation. Endoscopy shows a pulsatile extrinsic compression of the esophagus (aortic ring). The patient is currently being studied and closely monitored in the Cardiology consultation. Discussion The most common type of complete vascular ring is the double aortic arch, which accounts for 70% of the complete rings. In most cases, there are two permeable arches, usually with right dominance (70% of the cases). Rarely, both arches are symmetrical. Symptoms usually appear in the fifth month of life. In most cases, only supportive treatment is required. Conclusion This case illustrates the atypical features of this congenital malformation, namely the diagnosis during adulthood as well as the left dominance. Abstract P725 Figure. A double aortic arch

Anomalous origin of a pulmonary artery in a teenager with tetralogy of Fallot with associated double aortic arch and coronary arteriovenous fistula

2019 ◽  
Vol 29 (5) ◽  
pp. 727-729
Author(s):  
Vishal Agrawal ◽  
Parth Solanki ◽  
Ritesh Shah ◽  
Divyakant Parmar ◽  
Amit Mishra
Keyword(s):  
Pulmonary Artery ◽  
Aortic Arch ◽  
Tetralogy Of Fallot ◽  
Vascular Ring ◽  
Right Ventricular Outflow Tract ◽  
Left Pulmonary Artery ◽  
Ventricular Outflow Tract ◽  
Double Aortic Arch ◽  
Anomalous Origin ◽  
Tract Fistula

AbstractWe report the case of a 14-year-old female who had tetralogy of Fallot along with anomalous origin of the left pulmonary artery from the ascending aorta with co-dominant double aortic arch forming a complete vascular ring compressing the oesophagus along with a left main coronary artery to right ventricular outflow tract fistula. She underwent surgical correction without conduit placement.

Double aortic arch presenting as neonatal respiratory failure in the delivery room

2017 ◽  
Vol 28 (3) ◽  
pp. 476-478
Author(s):  
Marc Lee ◽  
T. K. Susheel Kumar ◽  
Govinda Paudel
Keyword(s):  
Respiratory Failure ◽  
Airway Obstruction ◽  
Aortic Arch ◽  
Respiratory Symptoms ◽  
Neonatal Period ◽  
Vascular Ring ◽  
Common Type ◽  
Double Aortic Arch ◽  
Delivery Room

AbstractRespiratory symptoms are prevalent in vascular ring anomalies, including double aortic arch, which is considered the most common type of vascular ring. However, respiratory failure owing to critical airway obstruction in the neonatal period is rare with few reported cases in the literature. We report a case of a newborn patient who required emergent intubation within the first few hours of life and was later discovered to have a double aortic arch.

scholarly journals Effectiveness of Repair of Aortic Coarctation in Neonates: A Long-Term experience

2021 ◽  
Author(s):  
Chiara Minotti ◽  
Manuela Scioni ◽  
Biagio Castaldi ◽  
Alvise Guariento ◽  
Roberta Biffanti ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Aortic Coarctation ◽  
Surgical Repair ◽  
Nyha Class ◽  
Long Term Results ◽  
Relative Risk Ratio ◽  
Hypoplastic Aortic Arch ◽  
Long Term Experience

AbstractTo evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in neonates. This is a retrospective clinical review of neonates with CoAo, who underwent surgery between 1995 and 2019. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by means of relative risk ratio and Cox and logistic multivariate analysis. 218 consecutive neonates (M/F: 129/89, median age 11 days, IQR 7–17 days) were included; 202 (92.7%) had a left thoracotomy; 178 underwent extended end-to-end anastomosis (EEEA, 81.6%). Hypoplastic aortic arch (HAA) was present in 102 patients (46.8%); complex cardiac anomalies in 85 (39%). Significant postoperative complications occurred in 20 (9.2%). Thirty-day mortality was 2.3% (most in complex types). At a median follow-up of 10.4 years (IQR 5.6–15.0 years; FU completeness 95.9%), there were 8 late deaths (3.7%), all associated to complex CoAo. Among 196 survivors, 177 (93.2%) were in NYHA class I; re-interventions on aortic arch occurred in 9.2% (2.0% were surgical). Freedom from mortality and re-intervention on aorta at 10 years were 94.3% and 96.7%, respectively. Surgical repair of CoAo in newborns without CPB in our series was safe and low-risk, with excellent early and late outcomes.

scholarly journals Double Aortic Arch – A Case Study

2017 ◽  
Vol 10 (1) ◽  
pp. 91-93
Author(s):  
Jahan Afroze ◽  
Musavvir Samin
Keyword(s):  
Aortic Arch ◽  
Clinical Skills ◽  
Vascular Ring ◽  
Final Diagnosis ◽  
Double Aortic Arch ◽  
Middle Aged ◽  
Ct Angiogram ◽  
Middle Aged Person ◽  
Aged Person ◽  
Arch System

Double aortic arch (DAA) is one of the 2 most common forms of vascular ring, a class of congenital anomalies of the aortic arch system in which the trachea and esophagus are completely encircled by connected segments of the aortic arch and its branches. The aim of this study is to describe a case of DAA in a middle aged person. A 40 year old male came to outdoor patient department with cough and breathlessness since childhood which was diagnosed earlier as bronchial asthma, cold allergy, and dust allergy. The final diagnosis DAA was made after CT angiogram. Establishing a diagnosis of DAA in a middle aged person requires thorough understanding and clinical skills in performing steps.Cardiovasc. j. 2017; 10(1): 91-93

Persistent wheezing along with apparent stridor caused by a rare anomaly: double aortic arch

2020 ◽  
pp. 004947552095990
Author(s):  
Şule Gökçe ◽  
Nüsabe Abdullayeva ◽  
Feyza Koç ◽  
Hüseyin Hüdaver Alper
Keyword(s):  
Aortic Arch ◽  
Vascular Ring ◽  
Common Type ◽  
Double Aortic Arch ◽  
Abnormal Development ◽  
Vascular Rings ◽  
Aortic Arch Anomaly ◽  
Rare Anomaly

Vascular rings are rare anomalies that occur as a result of abnormal development of the aortic arch complex, often manifested by signs of tracheo-oesophageal compression during the infant period. A double aortic arch anomaly is the most common type of vascular ring pathology. Here we report a case presenting with wheezing and stridor in a 10-month-old child.

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