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.