Unique Five Vessel Pattern Of Human Aortic Arch: A Case Report

We report here a unique vascular pattern of left sided aortic arch, detected incidentally in a 55 year old female,who underwent CECT chest for symptom of chronic cough. There were five vessels arising from the convex aspectof the arch with sequence as right common carotid artery (RCCA), left common carotid artery (LCCA), left vertebralartery (LVA), left subclavian artery (LSA) and aberrant right subclavian artery (ARSA).

Clues and techniques of prenatal ultrasonographic diagnosis for fetal aortic arch anomalies / 中华超声影像学杂志

Objective To explore the ultrasonographic features ,diagnostic clues and methods of fetal aortic arch anomalies ,and to improve the diagnosis rate of prenatal ultrasonography for fetal aortic arch anomalies . Methods Fetuses with aortic arch anomalies diagnosed by prenatal ultrasound were selected as the study objects . The prenatal ultrasonographic features of the three views of the aortic arch were carefully observed . The three views included the followings :the transverse view ( the view of three vessels and trachea) ,the sagittal view ( the longitudinal view of the aortic arch) ,and the coronal view ( the coronal view of the descending aorta) . The prenatal diagnostic clues and diagnostic techniques of aortic arch anomalies were summarized and analyzed . Results Eighty-one cases with aortic arch anomalies were followed up . Fifteen cases were left-sided aortic arch and left-sided ductus arteriosus with aberrant right subclavian artery ,22 cases with right aortic arch and left-sided ductus arteriosus with aberrant left subclavian artery ,4 cases were mirror right aortic arch and left-sided ductus arteriosus ,2 cases were mirror right aortic arch and right-sided ductus arteriosus ,11 cases were double aortic arch ,23 cases were coarctation of the aorta ,and 4 cases were interruption of aortic arch . Among them ,27 cases were complicated with other cardiac and extra-cardiac malformations and 13 cases with chromosomal abnormalities . Prenatal ultrasonographic clues for diagnosis of coarctation of the aorta included the three vessels and trachea view showing small diameter and disproportion to the diameter of the ductus arteriosus . And the longitudinal view of the aortic arch was helpful for showing the position and the extent of coarctation of the aorta . Prenatal ultrasonographic clues for diagnosis of interruption of aortic arch were that the three vessels and trachea view and the longitudinal view of the aortic arch showed the interruption between aortic arch and descending aorta . And the abnormal combination cases of the aortic arch segments also had their corresponding diagnostic clues . These clues included that the three vessels and trachea view showed abnormal position ,arrangement and running of the branches of the aortic arch . And the coronal view of the descending aorta also showed abnormal changes in the branches of aortic arch . Conclusions Various types of congenital aortic arch anomalies have characteristic ultrasonography and their corresponding diagnostic clues and methods . The combined use of the three views of the aortic arch is effective in prenatal diagnosis for aortic arch anomalies .

Fetal aortic arch and its branches anomalies: prenatal ultrasound, vascular cast and gene detection / 中华超声影像学杂志

Objective@#To explore the application values of prenatal ultrasound, vascular cast in the diagnosis of fetal aortic arch and its branches anomalies and to analyze the genetic characteristics by gene detection.@*Methods@#Twenty-two cases of the vascular cast specimens of the fetal aortic arch and its branches anomalies were analyzed and studied by comparing with their prenatal ultrasonography. Then the characteristics of each type of fetal aortic arch and its branches anomalies, the missed diagnosis and misdiagnosis were summarized and the results of their gene detection were also analyzed.@*Results@#The 22 cases of fetal aortic arch and its branches anomalies were as follows: 2 cases of double aortic arch showed the ascending aorta was divided into two branches after converging as the descending aorta. Three cases were left aortic arch with aberrant right subclavian artery. Twelve cases were right aortic arch: 8 cases were right aortic arch with mirror-image branching, 3 cases were right aortic arch with aberrant left subclavian artery, 1 case was right aortic arch with isolated left subclavian artery. Of the 8 right aortic arch with mirror-image branching, 3 cases of left arterial duct showed the vertical walking between the fusion site of the left innominate artery and the pulmonary artery. Right aortic arch with aberrant left subclavian artery with arterial duct showed "U" shaped vascular ring. Five cases were other types, including 2 cases of the coarctation of aortic arch, 1 case of interrupted aortic arch, 1 case of pulmonary artery sling, and 1 case of abnormal origin of right pulmonary artery. The ultrasonic missed diagnosis were the 6 deformities: 3 cases of arterial duct and 3 cases of aberrant subclavian artery. The ultrasonic misdiagnosis were the 5 deformities: 2 cases of arterial duct location, 1 case of aberrant subclavian artery, 1 case of isolated left subclavian artery, and 1 case of the coarctation of aortic arch. Genetic test results: In the 18 cases of the genetic detection, 2 cases were positive, 1 case was 22q11.2 microdeletion syndrome and 1 case was carrying KMT2D gene variant.@*Conclusions@#There are various kinds of fetal aortic arch and its branches anomalies, which are often associated with intracardiac malformations and venous branches variation. And prenatal ultrasound is of great value in diagnosing them.Vascular cast can visually display their characteristic changes, which is helpful to improve the differential diagnosis of the different aortic arch and its branches anomalies. The detailed genetic detection can improve the further understanding of its etiology.

Evaluation of Aortic Arch Anomalies by Echocardiography and CT Angiography, Could CT be the Primary Method of Diagnosis.

Aims: In our study we highlight the importance of noninvasive imaging, stressing the role of CTA over echocardiography in the diagnosis of congenital aortic arch anomalies. Study Design: Prospective design. Place and Duration of Study: Radiology and pediatric department, in Cairo University children’s hospital, over the period of 15 months from February 2011 to April 2012. Methodology: Forty five patients (23 males and 22 females) were examined in this study; they were referred to the pediatric cardiology outpatient clinic in Cairo university children’s hospital, by history or clinical examination suspicious of aortic arch anomalies. For each patient full history and clinical examination were obtained including: age, sex, residence, consanguinity, cardiac manifestations weak or absent femoral pulsations, abnormal gradient in blood pressure between upper and lower limbs (>20 mmhg). Echocardiography was done and if aortic arch anomalies were diagnosed; the patient referred to do CT angiography of the heart after taking clear consent from the patient’s parents. Results: Our study included 45 patients, their age range (5 days -11 years), they were 23 males and 22 females, with the following diagnosis: 15 had hypoplastic aortic arch by echocardiography, 6 of them proved to have multiple levels of narrowing by CT angiography, 11patients had aortic coarctation by echocardiography, 3 of them were proved to have more than one segmental narrowing by CT angiography and one patient had hypoplasia of the whole aorta. Six patients had tetralogy of Fallot with right sided aortic arch, mirror imaging branches or aberrant left subclavian artery and hypoplastic pulmonary trunk. Four patients had interrupted aortic arch. One patient had aneurysmal dilatation of ascending aorta and aortic arch. One patient had aortopulmonary window. Six patients had persistent truncus arteriosus.

Congenital Anomalies of the Aortic Arch: Evaluation with the Use of Multidetector Computed Tomography

Congenital anomalies of the aortic arch have clinical importance, as the anomalies may be associated with vascular rings or other congenital cardiovascular diseases. Multidetector computed tomography (MDCT) angiography enables one to display the detailed anatomy of vascular structures and the spatial relationships with adjacent organs; this ability is the greatest advantage of the use of MDCT angiography in comparison to other imaging modalities in the evaluation of the congenital anomalies of the aortic arch. In this review article, we illustrate 16-slice MDCT angiography appearances of congenital anomalies of the aortic arch.

Surgical Management of Coarctation of the Aorta with a Ventricular Septal Defect and Coexisting Partial Anomalous Pulmonary Venous Connection: A case report / 대한흉부외과학회지

A newborn girl with a partial anomalous pulmonary venous connection, coarctation of the aorta, and ventricular and atrial septal defects underwent a complete repair successfully at 19 days of age. In this case, the left upper pulmonary vein was connected to the left innominate vein via an atypical vertical vein.

Congenital absence of ductus arteriosus: an autopsy case

Isolated absence of the ductus arteriosus is extremely rare condition although the ductus arteriosus may be hypoplastic or aplastic in association with other aortic arch anomalies. Authors described a case of isolated agenesis of the ductus arteriosus documented by postmortem examination of a newborn infant who died of pneumonia following operation for a large omphalocele. The heart showed ventricular septal defect. However, no other cardiovascular anomalies were associated in this case. There were three vessels that were taking off from the aorta consisted of the right brachiocephalic artery, left common carotid-artery and left subclavian artery. The anteriorly located pulmonary artery was divided into the right and left pulmonary arteries. There was no connection of vessel between the pulmonary artery and the aorta.