KEYWORDS
Double aortic arch; vertebral artery; enhanced CT.
A 3-year-old girl with a history of respiratory distress was referred to emergency department, The patient was afebrile on initial evaluation with a heart rate of 110, blood pressure of 75/40 mmHg, and an oxygen saturation of 99% on room air. no wheezing, crackles were present on the auscultation of the lungs, and EKG showed normal sinus rhythm. Chest x-ray showed tracheal indentation and suspicion of tracheal stenosis. Echocardiography was not conclusive but raised the possibility of Double aortic arch (DAA) . She was therefore referred for cardiac enhanced CT. The result revealed a DAA with arch origins for left common carotid, left vertebral, and left subclavian on the left , and right common carotid, right vertebral, and right subclavian arteries on the right(figure 1A and 1B).The girl subsequently underwent division of the left arch, distal to the origin of the left subclavian artery to relieve the vascular compression on the trachea. Postoperative recovering was uneventful.
Double aortic arch (DAA) is a exceedingly rare congenital vascular anomaly, with one in 15,000 births accounting for only 1% of all congenital heart diseases1. This disease is the most common type of complete vascular ring, which easily compresses the trachea and/or esophagus to cause A spectrum of signs and symptoms such as dysphagia, vomiting, respiratory distress, wheezing, and stridor2. Vertebral artery (VA) typically emanates from the supero-posterior aspect of the 1st part of the subclavian artery and Variations of the VA origin usually occur in the congenital heart disease3. We herein report a double aortic arch, with arch origins for left common carotid, left vertebral, and left subclavian on the left , and right common carotid, right vertebral, and right subclavian arteries on the right . To our knowledge, a DAA with a direct aortic origin of the right and left VA from two arches have not been reported.
Therefore Enhanced CT should be considered in DAA patients to identify the anomalous originĀ of branch arteries, because noninvasive cardiovascular imaging have unveiled rare variations in aortic arch and such insights not only aid in surgical planning but also deepen our comprehension of potential embryological variations in aortic arch development.