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[Double aortic arch: report of one case]
Insights
A rare congenital vascular anomaly, double aortic arch, can cause severe respiratory distress in infants. Surgical division of the smaller arch effectively relieves tracheal compression and resolves symptoms.
Area of Science:
- Cardiology
- Pediatric Surgery
- Medical Imaging
Background:
- Double aortic arch is a rare congenital vascular anomaly where the aorta forms two arches.
- This condition can lead to significant compression of the trachea and esophagus, causing respiratory and feeding difficulties in infants.
Observation:
- An 11-month-old male presented with persistent stridor, recurrent respiratory infections, and dyspnea since birth.
- Symptoms worsened, necessitating intubation and mechanical ventilation due to severe respiratory obstruction and cyanosis.
- Diagnostic imaging, including bronchogram, esophagogram, and cardiac catheterization, confirmed the presence of a double aortic arch.
Findings:
- Surgical intervention via left thoracotomy involved dividing the smaller left arch and the ligamentum arteriosum.
- This procedure successfully relieved the extrinsic compression of the trachea by the vascular ring.
- The patient experienced a normal postoperative recovery with resolution of symptoms.
Implications:
- Double aortic arch presents with variable symptoms, from mild to life-threatening airway obstruction.
- Characteristic findings include inspiratory stridor and dyspnea, often exacerbated by feeding or infections.
- Esophagography is crucial for diagnosis, and surgical division of the anomalous arch offers the definitive treatment.
Abstract:
A case of double aortic arch is reported. The male patient, 11-month-old, had breathed with a constant stridor since his birth and had frequent attacks of respiratory tract infection and dyspnea. The child was admitted because of restlessness, fever, stridor and cough. Dyspnea with cyanosis appeared later, and required intubation and mechanical ventilation. After then, three attempts to extubate the infant were made, but failed. A double aortic arch was suspected by bronchogram, esophagogram, and confirmed by cardiac catheterization. Through a left thoracotomy, the smaller left arch and the ligmentem arteriosum were divided to relieve the obstruction of trachea from the compression of the vascular ring. Postoperative convalescence was normal. Symptoms of double aortic arch vary with the degree of obstruction of the trachea and esophagus, ranging from mild to life-threatening respiratory obstruction and apnea. Inspiratory stridor, dyspnea, and wheezing, which are accentuated with feeding, crying, or respiratory infections, are characteristic clinical findings. The diagnosis is established by aid of an esophagography. Left thoracotomy, with division of the smaller aortic arch, is the only satisfactory treatment.