Related Experiment Video

Updated: Oct 13, 2026

Three-Dimensional Printing of a Complex Aortic Anomaly

Three-Dimensional Printing of a Complex Aortic Anomaly

Published on: November 1, 2018

Surgical approach to complicated cervical aortic arch: anatomic, developmental, and surgical considerations

D B McElhinney¹, L D Thompson, P M Weinberg

¹Division of Cardiothoracic Surgery, University of California, San Francisco, USA.

Cardiology in the Young

|May 29, 2000

Insights

Patients with a cervical aortic arch often have associated brachiocephalic arterial and arch abnormalities. Surgical repair of these complex congenital heart defects is successful, with no long-term complications observed in this study.

Area of Science:

Cardiovascular Surgery
Congenital Heart Disease
Vascular Anomalies

Background:

Cervical aortic arch is frequently associated with abnormal brachiocephalic arterial branching and arch laterality.
Structural anomalies, including obstruction, aneurysms, and tortuosity, are common in cervical aortic arch cases.

Purpose of the Study:

To evaluate surgical outcomes for patients with obstructed right cervical aortic arch and associated anomalies.
To analyze the spectrum of anatomical variations and surgical strategies in this patient cohort.

Main Methods:

Retrospective review of 6 patients with obstructed right cervical arch between 1990 and 1998.
Surgical repair techniques included patch augmentation aortoplasty, tube grafting, and direct anastomosis.
Detailed analysis of vascular ring presence, vessel origin abnormalities, and descending aorta laterality.

Main Results:

All 6 patients underwent successful surgical repair without perioperative complications.
Follow-up (1-9 years) showed all patients alive and well, with no recurrence of obstruction.
One patient had a 22q11 microdeletion; associated anomalies included aneurysms, tortuosity, and vascular rings.

Conclusions:

Structural anomalies are common in cervical aortic arch patients, potentially due to hemodynamic factors or abnormal vascular tissue.
Surgical approaches must be tailored to the highly variable anatomy of complicated cervical aortic arches.
Successful surgical management is achievable for these complex congenital vascular anomalies.

Read full analysis

Abstract

Background:

Abnormalities of brachiocephalic arterial branching and arch laterality are common in patients with a cervical aortic arch. In addition, structural anomalies of the arch such as obstruction, aneurysms, and tortuosity are found in a significant number of cases.

Methods:

Between 1990 and 1998, 6 patients underwent surgery for an obstructed right cervical arch. A significant obstruction was present at the transverse or distal arch in all patients, and was recurrent after previous repair in 2. In 1 patient, there was also a multi-lobed aneurysm of the aortic segment contiguous to the obstruction, and in 2 there was marked tortuosity of the arch. In all cases, the order of origin of the head and neck vessels was abnormal, and obstruction of 1 or more brachiocephalic vessels was found in 3. A vascular ring was present in all patients, with a right aortic arch and aberrant left subclavian artery in 4 patients and a double aortic arch with a dominant right cervical arch in 2. The descending aorta was circumflex (left-sided) in 3 patients. Three patients were repaired through a standard right posterolateral thoracotomy, and 3 through a median sternotomy. Patch augmentation aortoplasty was used in 2 patients, a tube graft from the ascending to descending aorta in 2, end to side anastomosis of the descending aorta to the proximal arch in 1, and direct anastomosis to reconstruct an atretic left-sided component of a double arch in 1.

Results:

Repair was successful in all cases, with no perioperative complications. At follow-up ranging from 1 to 9 years, all patients were alive and well, with no recurrence of arch obstruction or other significant complications. Fluorescent in situ hybridization revealed microdeletion of chromosome 22q11 in 1 patient (not performed in the others).

Conclusions:

Structural anomalies of the arch are relatively common in patients with a cervical aortic arch. Such abnormalities may be the result of hemodynamic conditions and/or abnormal vascular tissue related either to the cervical position of the arch or its embryologic precursors. Given the highly variable anatomy of patients with a complicated cervical aortic arch, surgical considerations will vary in kind.

More Related Videos

Novel and Innovative Hybrid Technique for Type A Aortic Dissection

Novel and Innovative Hybrid Technique for Type A Aortic Dissection

Published on: March 28, 2025

Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm

Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm

Published on: August 1, 2025

Related Concept Videos

The Arch of Aorta

The Arch of Aorta

The coronary arteries, originating from the ascending aorta, bifurcate from two sinuses located within the ascending aorta. Positioned just above the aortic semilunar valve, these sinuses house essential aortic baroreceptors and chemoreceptors, crucial for maintaining cardiac function. The left coronary artery and the right coronary artery branch off from the left posterior and anterior aortic sinuses, respectively.
Encircling the heart, the coronary arteries form a ring-like structure before...

Aortic Regurgitation I: Introduction

Aortic Regurgitation I: Introduction

IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...

Aortic Regurgitation III: Medical Management

Aortic Regurgitation III: Medical Management

Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...

Aneurysm I: Introduction

Aneurysm I: Introduction

An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...

Aneurysm II: Clinical Manifestations and Diagnostic Studies

Aneurysm II: Clinical Manifestations and Diagnostic Studies

Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...

Aneurysm III: Interprofessional Care

Aneurysm III: Interprofessional Care

Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...

Articles linked to this work by shared authors, journal, and citation graph.

Nutrient composition and retention in whole turkeys with and without added solution.

Poultry science·2017

Nutrient database improvement project: Separable components and proximate composition of raw and cooked retail cuts from the beef loin and round.

Meat science·2015

Low rate of prenatal diagnosis among neonates with critical aortic stenosis: insight into the natural history in utero.

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology·2014

Nutrient database improvement project: the influence of USDA quality and yield grade on the separable components and proximate composition of raw and cooked retail cuts from the beef chuck.

Meat science·2014

Survivability of Escherichia coli O157:H7 in mechanically tenderized beef steaks subjected to lactic acid application and cooking under simulated industry conditions.

Journal of food protection·2013

Nutrient database improvement project: the influence of U.S.D.A. Quality and Yield Grade on the separable components and proximate composition of raw and cooked retail cuts from the beef rib and plate.

Meat science·2013

See all related articles