Truncus arteriosus with double aortic arch: A rare association

A rare adult case of asymptomatic double aortic arch accompanied by the right vertebral artery directly originating from the aortic arch

INTRODUCTION

A double aortic arch (DAA) is a rare congenital vascular anomaly. No case of DAA with a direct aortic origin of the right vertebral artery (VA) has been reported in adults. Here, we report a rare case of an asymptomatic DAA accompanied by the right VA directly originating from the right aortic arch in an adult.

CASE PRESENTATION

A DAA and right VA directly originating from the right aortic arch were identified in a 63-year-old man using digital subtraction angiography and computed tomography angiography. The patient underwent digital subtraction angiography for evaluation of an unruptured cerebral aneurysm. Intraprocedural selection of vessels branching from the aorta with the catheter was difficult. To confirm the bifurcation of the aorta, aortography was performed, which revealed a DAA. Following digital subtraction angiography, computed tomography angiography was performed, which showed that the right VA originated directly from the right aortic arch. The trachea and esophagus were located in the vascular ring of the DAA; however, they were not compressed by the aorta. This was consistent with the lack of symptoms related to the DAA.

CONCLUSIONS

This is the first adult case of an asymptomatic DAA with an unusual origin of the VA. A rare asymptomatic vascular anomaly, such as a DAA, can be incidentally identified using angiography.

A rare case of common arterial trunk with coarctation of the aorta: a case report

Background

A common arterial trunk is a relatively uncommon type of congenital heart defect. The anomaly is caused by an incomplete conotruncal septation. Arch anomalies, such as interruption, are associated with 10–20% of cases. We present a rare case of common arterial trunk with coarctation of the aorta and patent ductus arteriosus (PDA).

Case summary

A term baby who was discovered to have a murmur on examination, for evaluation of the murmur an echocardiography was performed on Day 2 of life, which revealed the diagnosis of a common arterial trunk and coarctation of the aorta. The baby was given prostaglandin and intubated. Due to his poor general condition, he underwent an emergency pulmonary artery branch banding. He needed another 5 days in the intensive care unit to be stabilized before undergoing full repair.

Discussion

Our patient has a common arterial trunk with a tricuspid competent truncal valve. The trunk is subdivided further into ascending aorta and main pulmonary artery. The pulmonary artery provided two branches and a PDA that connected to the descending aorta. The aortic branching pattern was as usual, there was an area of tight coarctation and posterior shelf just after the origin of the left subclavian artery before the descending aorta–PDA junction. The presence of coarctation may be considered as the left side of the spectrum of morphological changes toward the formation of aortic arch interruption (Type 4 Van Praagh).

Anatomical Variations of the Aortic Arch: A Computerized Tomography-Based Study

Introduction

Despite adequate preparation and meticulous pre-operative assessment, variations of the vascular anatomy of the aortic arch may lead to clinical dilemmas. In the present era, with the easy availability of imaging facilities, various anatomical variations can be found out prior to an interventional procedure. However, there are many countries including India where such facilities may still be not widely available. The purpose of this study was to assess the prevalence of these anatomical variants in patients undergoing Computerised Tomography (CT) chest with contrast.

Methods

This observational study involved patients who underwent CT chest with contrast as part of various clinical indications during a three-year period in a tertiary care centre in South India. Variations of the aortic arch and its branching pattern were studied in 4,000 chest CT images of patients referred to the radiology department. 

Results

A total of 4,000 patients underwent CT chest with contrast during the study period. Twenty-seven variations were observed in these patients. They included aberrant right subclavian artery in seven patients, bovine arch in one patient, bovine origin of left vertebral artery from arch in one patient, bronchial artery of anomalous origin from arch in one patient, double aortic arch in one patient, and right-sided aortic arch in 16 patients. 

Conclusion

The variant anatomy of the aortic arch has tremendous clinical significance, especially from the surgical standpoint. Anatomical variants can also cause difficulty during catheterization while performing endovascular interventions. Given the prevalence demonstrated in our study, imaging may be indicated prior to any procedure involving vascular access in order to prevent unwanted complications.