![]() posterior indentation on lateral view produced by the encircling posterior arch (mostly right-sided aortic arch component)Ĭontrast-enhanced cross-sectional imaging is required to confirm the diagnosis and also to delineate details of anatomy in particular right or left arch dominance for surgical planning.classic "reverse S" indentation of the contrast column on frontal view produced by an upper indentation of the right-sided aortic arch and the lower indentation is by the left-sided aortic arch.Fluoroscopy: barium swallowĬontrast swallow studies are more helpful and demonstrate: Lack of air column in the thoracic portion of the trachea is sometimes seen. Right-sided aortic arch indenting the trachea and increase right paratracheal soft tissue thickness. It is rarely associated with congenital heart disease 12,13. When the minor arch is markedly hypoplastic or atretic ( incomplete double aortic arch), the affected segment tends to be almost always distal to the left subclavian artery 9. This anomaly is caused by persistence of the right and left embryonic fourth aortic arches, which results in formation of a vascular ring from the splitting of the ascending aorta into two limbs that pass to either side of the trachea and oesophagus 5 (both of which get encircled), which then join as a single descending aorta. All rights reserved.Double aortic arch is mostly diagnosed in childhood due to symptoms related to oesophageal and/or tracheal obstruction. Respiratory symptoms can be more common in infancy or early childhood while adult patients complain of difficulties in swallowing rather than respiratory difficulties due to tracheal development. In addition to dividing the smaller aortic arch and the ligamentum, we recommend excision of the KD.Ĭopyright © 2019 The Society of Thoracic Surgeons. Vascular ring patients with a double aortic arch can also have a KD. The remaining 5 patients reported substantial symptomatic relief with only minor respiratory symptoms. Five of the patients reported no related persisting symptoms. The postoperative length of stay was 3.1 ± 0.8 days. There were no major postoperative complications or readmissions. The mean size of the diverticulum was 9 × 10 mm. The left subclavian artery was transferred to the left carotid artery in 2 patients. All patients underwent division of their left aortic arch, division of the ligamentum, and resection of the KD. The distal left arch was atretic in all patients. All patients had preoperative computed tomographic angiography or magnetic resonance imaging and mean compression of the distal trachea of 63% ± 12% (range, 40% to 80%). The patients were a mean age of 4.9 ± 4.3 years (range, 6 months to 29 years), and median age was 4 years. We performed a retrospective medical record review of these patients to characterize their demographics and outcomes.Īll 10 patients (7 male, 3 female) had a double aortic arch that was right dominant and also had a KD. Ten of those patients also had excision of a KD. We report on a less commonly seen subset of vascular ring patients-those with a double aortic arch and a KD.īetween 20, 66 patients underwent an operation for a double aortic arch. Vascular rings with a Kommerell diverticulum (KD) most commonly occur in patients with a right aortic arch.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |