Isolation of arch vessels: Imaging characteristics and associations on multidetector computed tomography angiography
Mumun Sinha1, Niraj N Pandey1, Nitin Parashar2
1Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.
Insights
Isolation of aortic arch branch vessels is a rare finding, most often associated with Tetralogy of Fallot (ToF). Multidetector computed tomography angiography (CTA) aids in diagnosing these rare vascular anomalies and associated conditions.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Pediatric Cardiology
Background:
- Isolation of aortic arch branch vessels is a rare congenital anomaly.
- Understanding its imaging characteristics and associations is crucial for diagnosis and management.
Purpose of the Study:
- To evaluate the imaging features of isolated aortic arch vessels using multidetector computed tomography angiography (CTA).
- To identify associated cardiac and extracardiac anomalies in patients with isolated arch vessels.
Main Methods:
- Retrospective review of multidetector CTA studies for congenital heart diseases (CHDs) from January 2014 to June 2020.
- Identification and characterization of isolated arch vessels, patent arterial duct, pulmonary artery, and aortic arch.
- Assessment of associated intra- and extracardiac anomalies.
Main Results:
- Isolation of arch vessels occurred in 0.36% of patients (14/3926).
- Left subclavian artery (SCA) was the most common isolated vessel (50%).
- Associated findings included right aortic arch (71.4%), patent arterial duct (50%), and Tetralogy of Fallot (ToF) (57.1%).
Conclusions:
- Isolation of aortic arch branch vessels is rare and frequently associated with ToF.
- Left SCA is the most commonly isolated vessel.
- CTA is valuable for diagnosing isolated arch vessels and associated anomalies, impacting patient management.
Aim:
To evaluate the imaging characteristics and associations in patients with isolation of arch vessels on multidetector computed tomography angiography (CTA).
Materials And Methods:
We retrospectively reviewed all multidetector CTA studies performed for the evaluation of congenital heart diseases (CHDs) at our institution from January 2014 to June 2020. Cases with isolation of arch vessels were identified. The isolated arch artery and its relationship with patent arterial duct, pulmonary artery, and aortic arch were characterized in addition to other associated intra- and extracardiac anomalies.
Results:
Isolation of arch vessels was seen in 14/3926 (0.36%) patients. Left subclavian artery (SCA) was the commonest isolated arch vessel, involved in 7/14 (50%) cases. Isolation of right SCA, left brachiocephalic artery, and left common carotid artery was seen in 4 (28.6%), 2 (14.3%), and 1 (7.1%) patient, respectively. The isolated arch vessel was seen associated with right aortic arch in 10/14 (71.4%) cases and was on the opposite side of aortic arch in all 14 (100%) patients. Right-sided nonrestrictive patent arterial duct was seen in 3/14 (21.4%) cases, left-sided nonrestrictive patent arterial duct was seen in 1/14 (7.1%) while a left-sided restrictive patent arterial duct was seen in 3/14 (21.4%) cases. Tetralogy of Fallot (ToF) was the commonest associated anomaly seen in 8/14 (57.1%) patients.
Conclusion:
Isolation of aortic arch branch vessels is rare, seen most commonly associated with ToF. Left SCA is the commonest involved vessel. CTA is useful not only in the diagnosis of isolation of arch vessels, but also in the presence or absence of associated anomalies which may impact the symptomatology, prognosis, and surgical management.
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