PMC3663154_01
AP Chest X ray demonstrating right aortic arch (arrow), clear lung fields without cardiomegaly.
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F1
Chest X ray demonstrated right aortic arch, clear lung fields without cardiomegaly (Fig 1).
Rigid laryngobronchoscopy demonstrating distal tracheal narrowing (arrow).
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F2
Because of worsening symptoms, he had a rigid laryngobronchoscopy performed, which revealed distal tracheal narrowing, as well as extrinsic, pulsatile compression of the distal left bronchus (Fig 2).
Supra sternal long axis view of an echocardiogram demonstrating a double aortic arch with a dominant right aortic arch
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F3
A smaller left aortic arch connecting to the descending aorta.
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Supra sternal short axis view demonstrating the vascular ring encircling the trachea and the esophagus (arrow).
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3D Rotational angiography demonstrating a double aortic arch with a hypoplastic left aortic arch and significant hypoplasia of the left isthmus (dashed line), connecting the left subclavian artery (full line) and a dominant right aortic arch (dotted line). A: anterior view.
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F6
The angiography was performed, while the patient was rapidly paced using transesophageal pacing catheter (Fig 6, highlighted in red), in order to reduce artifact and optimize images quality. The rotational angiogram and 3D reconstruction demonstrated a double aortic arch with a hypoplastic left aortic arch and significant hypoplasia (narrow lumen) of the left isthmus, connecting the left subclavian artery with the ductal ampulla (Fig 6-8).
3D Rotational angiography demonstrating a double aortic arch with a hypoplastic left aortic arch and significant hypoplasia of the left isthmus (dashed line), connecting the left subclavian artery (full line) and a dominant right aortic arch (dotted line). B: Posterior view.
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F7
The rotational angiogram and 3D reconstruction demonstrated a double aortic arch with a hypoplastic left aortic arch and significant hypoplasia (narrow lumen) of the left isthmus, connecting the left subclavian artery with the ductal ampulla (Fig 6-8).
3D Rotational angiography demonstrating a double aortic arch with a hypoplastic left aortic arch and significant hypoplasia of the left isthmus (dashed line), connecting the left subclavian artery (full line) and a dominant right aortic arch (dotted line). C: superior view.
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F8
The rotational angiogram and 3D reconstruction demonstrated a double aortic arch with a hypoplastic left aortic arch and significant hypoplasia (narrow lumen) of the left isthmus, connecting the left subclavian artery with the ductal ampulla (Fig 6-8).
Surgical view of the double aortic arch demonstrating the dissected left aortic arch giving rise to the left subclavian artery and connecting to the descending aorta. Anterior (ant), posterior (post), cephalic (ceph) and caudal (caud) orientation is noted.
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F9
Surgical repair (Fig 9) was performed through left posterolateral thoracotomy and included ligation, division and oversewing of the two ends of the left aortic arch.