Balanced Double Aortic Arch Causing Acute Tracheal Compression

AbstractObjective:We report the rare case of an oesophageal foreign body which lodged above the site of oesophageal compression by a double aortic arch.Methods:Case report and a review of the literature surrounding the classification, embryology, diagnosis and management of vascular rings and slings.Results:An eight-month-old male infant presented with symptoms of tracheal compression following ingestion of an oesophageal foreign body. Following removal of the oesophageal foreign body, the infant's symptoms improved initially. However, subsequent recurrence of respiratory symptoms lead to a repeat bronchoscopy and the diagnosis of a coexisting double aortic arch, causing tracheal and oesophageal compression.Conclusion:To our knowledge, this is only the second reported case of a double aortic arch being diagnosed in a patient following removal of an oesophageal foreign body.

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Tracheal Compression as a Result of a Double Aortic Arch: A Rare Cause of Dyspnea

Clinical Cardiology ◽

10.1002/clc.20537 ◽

2009 ◽

Vol 32 (9) ◽

pp. E65-E65 ◽

Cited By ~ 5

Author(s):

Muhammad Janjua ◽

Aaref Badshah ◽

Samuel A. Allen

Keyword(s):

Aortic Arch ◽

Double Aortic Arch ◽

Tracheal Compression

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Postnatal impact of a prenatally diagnosed double aortic arch

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-318946 ◽

2020 ◽

pp. archdischild-2020-318946

Author(s):

Trisha V Vigneswaran ◽

Milou PM Van Poppel ◽

Benedict Griffiths ◽

Paul James ◽

Haran Jogeesvaran ◽

...

Keyword(s):

Aortic Arch ◽

Double Aortic Arch ◽

Comparative Genomic Hybridisation ◽

Comparative Genomic ◽

Published Data ◽

Fetal Cardiology ◽

Tracheal Compression ◽

Postnatal Outcome ◽

Clinical Records

BackgroundA double aortic arch (DAA) is increasingly identified before birth; however, there are no published data describing the postnatal outcome of a large prenatal cohort.ObjectiveTo describe the associations, symptoms and impact of prenatally diagnosed DAA.MethodsRetrospective review of consecutive cases seen at two fetal cardiology units from 2014 to 2019. Clinical records including symptoms and assessment of tracheobronchial compression using flexible bronchoscopy were reviewed. Moderate–severe tracheal compression was defined as >75% occlusion of the lumen.ResultsThere were 50 cases identified prenatally and 48 with postnatal follow-up. Array comparative genomic hybridisation (aCGH) was abnormal in 2/50 (4%), aCGH was normal in 33/50 (66%) and of those reviewed after birth, 13 were phenotypically normal. After birth, there was a complete DAA with patency of both arches in 8/48 (17%) and in 40/48 (83%) there was a segment of the left arch which was a non-patent, ligamentous connection.Stridor was present in 6/48 (13%) on the day of birth. Tracheo-oesophageal compressive symptoms/signs were present in 31/48 (65%) patients at median age of 59 days (IQR 9–182 days). Tracheal/carinal compression was present in 40/45 (88%) cases. Seven of 17 (41%) asymptomatic cases demonstrated moderate–severe tracheal compression. All morphologies of DAA caused symptoms and morphology type was not predictive of significant tracheal compression (p=0.3).ConclusionsGenetic testing should be offered following detection of double aortic arch. Early signs of tracheal compression are common and therefore delivery where onsite neonatal support is available is recommended. Significant tracheal compression may be present even in the absence of symptoms.

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