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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
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[Double aortic arch: clinical aspects, diagnosis and therapy in children and adults]

C Brockes1, P R Vogt, T B Rothe

  • 1Abteilung für Kardiologie, Universitätsspital Zürich, Rämistr. 100 8091 Zürich, Schweiz.

Zeitschrift Fur Kardiologie
|March 27, 2001
PubMed

Insights

Double aortic arch, a rare vascular anomaly, often causes airway compression in infants. Surgical resection of the smaller arch effectively resolves symptoms, even in oligosymptomatic adults.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Surgery
  • Medical Imaging

Background:

  • Double aortic arch is a rare congenital vascular anomaly.
  • It frequently leads to tracheal and esophageal compression in infants, causing significant symptoms.
  • Delayed diagnosis can occur, even into adulthood, despite early childhood indicators.

Purpose of the Study:

  • To evaluate symptoms, diagnostic methods, and treatment outcomes for double aortic arch.
  • To emphasize the importance of early diagnosis and surgical intervention.
  • To assess the utility of advanced imaging techniques in diagnosis.

Main Methods:

  • Retrospective review of 8 patients (7 children, 1 adult) treated over 30 years.
  • Analysis of presenting symptoms, diagnostic imaging (esophagography, bronchography, angiography, MRI, CT), and surgical procedures.
  • Evaluation of surgical outcomes following resection of the smaller aortic arch.

Main Results:

  • Common symptoms included dyspnea, stridor, recurrent pulmonary infections, feeding difficulties, and failure to thrive.
  • Diagnostic imaging confirmed tracheal and esophageal compression in most patients.
  • Surgical resection of the smaller aortic arch, performed via posterolateral thoracotomy, was successful in all patients, resolving symptoms completely.
  • Magnetic resonance angiography and computed tomography proved effective alternatives to conventional angiography.

Conclusions:

  • Prompt diagnosis and surgical treatment of double aortic arch in early childhood are crucial.
  • Surgical resection of the smaller aortic arch is recommended even for oligosymptomatic patients to prevent future complications.
  • Less invasive imaging modalities like MRI and CT can replace preoperative angiography.

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