PMC9807665_01
(A-C) Preoperative echocardiographic images from the neonatal period showing hyperechogenicity and severe narrowing of the aortic arch with a 2.5 mm diameter of the descending aorta lumen (gradient of 90mmHg) and normal coronary arteries; (D-F) postoperative echocardiographic images from the neonatal period showing the brightness and the abnormal echogenicity of the walls of the aortic arch and descending aorta and calcified residual masses at the level of the aortic arch extended to the brachiocephalic trunk, left common carotid artery, left subclavian artery, with laminar color Doppler flow in the descending aorta. Diameter of descending aorta lumen of 5.5 mm; (G-I) echocardiographic images at 3 months of age showing re-coarctation of the aorta with a significant gradient and the persistence of the aortic arch calcifications; (J-L) echocardiographic images at 18-months of age showing the regression of the aortic arch calcifications without obstruction, and mild left ventricular hypertrophy.
fcvm-09-1032519-g001.jpg
PMC9807665_01_fcvm-09-1032519-g001.jpg
F1
Transthoracic echocardiography showed left ventricular hypertrophy with impaired systolic function (LV ejection fraction of 40%), severe pulmonary hypertension, hyperechogenicity and severe narrowing of the aortic arch and descending aorta, with a significant gradient of 90 mmHg (Figures 1A,B). The coronary arteries were normal (Figure 1C). Postoperative echocardiography showed the brightness and the abnormal echogenicity of the walls of the aortic arch and descending aorta and calcified residual masses at the level of the aortic arch, with a 9 mm extension to the brachiocephalic trunk (BT), LCCA, LSA, with laminar color Doppler flow in the aorta (Figures 1D-F). Echocardiography revealed a significant narrowing of the aortic isthmus (Figures 1G-I). Echocardiography showed that the vascular calcifications of the aortic arch and its branches were still present but were not progressing (Figures 1J-L), however, CT scan confirmed the regression of the aortic arch calcifications without stenosis (Figures 3E,F).
The calcified mass extracted intraoperatively from the left subclavian artery (A), the aortic arch (B), and the left common carotid artery (C).
fcvm-09-1032519-g002.jpg
PMC9807665_01_fcvm-09-1032519-g002.jpg
F2
Intraoperatively, after aortotomy, a calcified mass extended to the aortic arch, the left subclavian artery (LSA) and the left common carotid artery (LCCA) was detected and partially removed, and an end-to-end anastomosis was performed (Figure 2).
(A,B) Computed tomography images from the neonatal period showing extensive ectopic calcifications in the aortic arch, brachiocephalic trunk, left common carotid artery, left subclavian artery and descending aorta with severe narrowing of the aorta mimicking coarctation of the aorta. Note the brightness of the walls of the aortic arch and descending aorta; (C,D) computed tomography images at 3-months of age showing re-coarctation of the aorta and residual calcifications in the brachiocephalic trunk and left common carotid artery without obstruction; (E,F) computed tomography images at 18-months of age showing the regression of the aortic arch calcifications without stenosis.
fcvm-09-1032519-g003.jpg
PMC9807665_01_fcvm-09-1032519-g003.jpg
F3
Both preoperative ultrasound images and CT acquisitions were retrospectively reviewed (Figure 3). Extended areas of increased echogenicity (compatible with calcifications) throughout the aortic arch extending into BT, LCCA, LSA, and descending aorta with severe narrowing of the aorta were noted (Figures 3A,B). CT scan confirmed the aortic re-coarctation and showed improvement of his residual aortic arch calcifications (Figures 3C,D). Echocardiography showed that the vascular calcifications of the aortic arch and its branches were still present but were not progressing (Figures 1J-L), however, CT scan confirmed the regression of the aortic arch calcifications without stenosis (Figures 3E,F).
PMC9807665_02