Diagnosis of the double aortic arch and its differentiation from the conotruncal malformations

Surgical treatment of double aortic arch malformation combined with descending aortic arch dissection in adults: a case series

BACKGROUND

Double aortic arch (DAA) combined with descending aortic arch dissection (DAAD) in adults is a rare aorta vascular disease. Due to the abnormal anatomy of the double arch and arch vessels, the clinical symptoms and surgical methods differ from those of typical aortic dissection.

METHODS

This study was retrospective analysis of a case series involving three patients (mean age, 47.3 years) with DAA combined DAAD underwent total arch replacement or hybrid aortic repair from September 2010 to June 2019. The patients' demographics, initial symptoms, comorbidities, surgical procedures, and outcomes are summarized.

RESULTS

Total arch replacement plus frozen stent implantation under deep hypothermic circulatory arrest was performed for 2 patients, one of them developed disseminated intravascular coagulation and multiple organ failure postoperatively. Case 3 underwent a hybrid procedure with left subclavian artery revascularization and thoracic endovascular aortic repair. The symptoms of hoarseness and dysphagia were obviously improved during the follow up.

CONCLUSION

In addition to typical sudden chest and back pain, patients with DAA and DAAD may have hoarseness and dysphagia. Based on the development of DAA, total arch replacement or hybrid surgery may be is an optional treatment.

Balanced double aortic arch demonstrated by multimodality image and 7-year follow-up in a symptomatic elderly patient: A case report

Double aortic arch is a very rare congenital heart disease. Double aortic arch forms a vascular ring, compressing the esophagus and trachea, causing symptoms mainly in infants and young children, and symptoms rarely appear after adulthood. The management of double aortic arch depends on the severity of the symptoms, but since aging exacerbates atherosclerosis and complicates surgery, treatment in adults has many considerations. A 55-year-old woman admitted for chest discomfort, mild dyspnea and mild dysphagia. On a simple chest X-ray, dilated upper mediastinum and bilateral aortic knobs were noted. Transthoracic echocardiography revealed 2 aortic arches on suprasternal view. Contrast-enhanced computed tomography and 3-dimensional computed tomography demonstrated a balanced double aortic arch which formed a complete vascular ring and compressed the esophagus. Barium esophagogram showed marked luminal narrowing at the aortic arch level, probably due to indentation of the double aortic arch. She had several risk factors regarding progression of aortic atherosclerosis include old age, hypertension and dyslipidemia that make more severe compression of esophagus and trachea, but the symptoms were not severe, so we decided to observation while controlling the risk factors. For the next 7 years, she stayed without worsening of symptoms.

A case of balanced type double aortic arch diagnosed incidentally by transthoracic echocardiography in an asymptomatic adult patient

A 36-year-old male patient with no remarkable medical history was admitted to our hospital for a health check up. On chest radiography, bilateral aortic notches at the level of aortic arch were shown suggesting aortic arch anomaly without any clinical symptoms. Two aortic arches were almost same-in-size on suprasternal view of transthoracic echocardiography. In addition, multidetector computed tomography showed balanced type double aortic arch forming a complete vascular ring which encircled the trachea and esophagus. The trachea was slightly compressed by the vascular ring whereas the esophagus was intact. Nevertheless, the pulmonary function test was normal. The patient was discharged from hospital with instructions for periodic follow-up.