Double innominate vein in a case with double aortic arch: a case report

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Thoracic Surgery

Background:

• Double aortic arch (DAA) is a congenital vascular ring anomaly that can compress the trachea and esophagus, leading to symptoms like stridor and dysphagia.
• Double innominate veins represent a rare venous anomaly that usually remains asymptomatic and does not require intervention.

Observation:

• A 2-month-old infant presented with stridor and a hoarse voice, diagnosed with DAA, atrial septal defects, and a double innominate vein.
• The double innominate veins were noted to traverse the mediastinum without contributing to airway compression.
• Surgical resection of the atretic segment of the DAA was performed via lateral thoracostomy at 4 months of age, successfully releasing the vascular ring.

Findings:

• The DAA was the cause of the infant's airway symptoms, necessitating surgical intervention.
• The double innominate vein was an incidental finding and did not require operative management.
• Early surgical release of the DAA prevented potential airway complications such as bronchomalacia.

Implications:

• Early diagnosis and surgical intervention for symptomatic DAA are crucial to prevent or minimize airway complications in infants.
• Routine surgical release of asymptomatic double innominate veins is not indicated.
• This case highlights the importance of differentiating between DAA and double innominate veins for appropriate management strategies.