What Is a Double Aortic Arch?

The double aortic arch is a congenital aortic arch dysplasia. The ascending aorta is divided into left anterior arch and right posterior arch. The left anterior arch passes from the trachea to the left in the normal direction. The right posterior arch spans the right main trachea and passes through the trachea and the esophagus. The two bows merge into the descending aorta. Double descending aorta can also be formed along the left and right sides of the spine. Arterial catheters can be left or right or even bilateral. The double aortic arch surrounds the trachea and esophagus, which can compress the trachea and cause difficulty in breathing, and compress the esophagus and cause difficulty in swallowing. Symptoms should be treated with surgery, and the smaller bow is cut to relieve compression. ^[1]

Double aortic arch

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The double aortic arch is a congenital aortic arch dysplasia. The ascending aorta is divided into left anterior arch and right posterior arch. The left anterior arch passes from the trachea to the left in the normal direction. The right posterior arch spans the right main trachea and passes through the trachea and the esophagus. The two bows merge into the descending aorta. Double descending aorta can also be formed along the left and right sides of the spine. Arterial catheters can be left or right or even bilateral. The double aortic arch surrounds the trachea and esophagus, which can compress the trachea and cause difficulty in breathing, and compress the esophagus and cause difficulty in swallowing. Symptoms should be treated with surgery, and the smaller bow is cut to relieve compression. ^[1]

A complete vascular ring is formed by the aortic arch on both sides of the blood vessels and the esophagus. Accompanied by anterior ascending aortic arch and posterior esophageal aortic arch or posterior descending aorta. The arterial catheter is usually on the left side and is not a necessary part of the vascular ring, but its length can affect the severity of clinical symptoms. Only 22% of patients have congenital heart malformations. Mainly tetralogy of Fallot and complete aortic transposition. Symptoms of children with bi-aortic arch may be more serious. Clinical manifestations include inspiratory wheezing, dysphagia, long-term cough, tilted head, body angle, and pneumonia, often holding breath and cyanosis. The chest radiograph shows unilateral or bilateral lung field hyperinflation, which is caused by obstruction of the main part of the trachea or bronchus. Examination of barium in the esophagus shows serrated notches on both sides of the esophagus (or the right side). , And the indentation on the right side is deeper, and a large posterior indentation in the lateral and left anterior oblique chest radiographs is characteristic of the posterior esophageal aortic arch.

This malformation has no obvious hemodynamic effect, but if the arterial ring formed by it is narrow, and the pulmonary artery can be pulled tightly, it can compress the trachea and esophagus and cause symptoms such as respiratory distress, respiratory infection and dysphagia.

Chest x-ray

Without other cases of congenital heart malformation, the chest radiograph may be normal. Cases of bi-aortic arches show bilateral aortic arch bulges, more pronounced on the right. Esophageal angiography can show indentations on both sides of the upper esophagus at the 3rd and 4th levels of the thoracic spine. The indentation caused by the right aortic arch is larger and higher, and the indentation caused by the left aortic arch is smaller and lower. Tomography may show signs of compression of the trachea. On the right aortic arch, a chest x-ray showed only a spherical aortic bulge on the right side, but the left side was absent. Esophageal angiography was performed on the aortic arch, and the esophagus was pushed to the left and showed pressure marks. In the case of ectopic subclavian arteries, esophageal angiography can show oblique or spiral impressions on the posterior wall of the esophagus due to vascular compression. Infant cases for esophageal angiography should use lipiodol or water-soluble contrast agents. Barium contrast agents, such as inhaled into the tracheobronchial, may increase the difficulty of breathing or cause aspiration pneumonia. Bronchoscopy

Bronchoscopy can identify the location of the tracheal compression, and blood vessel pulsation can be observed in the compressed area. However, the respiratory mucosal trauma and edema caused by respiratory tract obstruction can aggravate respiratory tract obstruction, and must be very careful. Aortic angiography

Aortic angiography is the most reliable method for the diagnosis of aortic arch and its branch malformations. A catheter is inserted into the ascending aorta, and a contrast agent is injected for the aorta and its branches. The two-way film imaging examination can show the origin, direction, thickness and other abnormalities of the aortic arch and its branches, thereby confirming the diagnosis.

The disease is serious and requires prompt surgical treatment. There are also many surgical complications, including cardiac insufficiency, arrhythmia, and pulmonary hypertension crisis.

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