87
views
0
recommends
+1 Recommend
1 collections
    0
    shares

      To submit to this journal, click here

      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Double arc aortique: à propos de deux cas Translated title: Double aortic arch: about two cases

      case-report

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Le double arc aortique représente une anomalie rare de l’arc aortique. Il provient de l’absence d’involution de l’aorte dorsale caudale. La symptomatologie clinique est habituellement précoce, notée dès la période néonatale ou peu après, dominée par des signes respiratoires et digestives. Le TOGD permet un diagnostic précis de l’anomalie. Cependant, l’angiographie est d’un grand intérêt diagnostique ainsi que dans le choix de l’approche thérapeutique. Seul le traitement chirurgical permet de lever les signes compressifs sur l’axe trachéo-oesophagien. L’objectif de notre travail est d’illustrer à travers deux observations de double aortique chez deux patients âgés respectivement de 7 mois et 9 mois, l’apport de l’imagerie dans le diagnostic difficile de cette anomalie.

          Translated abstract

          Double aortic arch is a rare anomaly of the aortic arch. It is due to the absence of involution of the caudal dorsal aorta. The disease usually begins to show itself in very early clinical signs, already detectable in the neonatal period. Angiography is of great interest to its diagnosis as well as to the choice of the therapeutic approach. Only surgical treatment allows to eliminate tracheoesophageal compression. Surgical mortality rate is low thanks to the progress of postoperative resuscitation. We here report two cases of double aortic arch in order to highlight the contribution of imaging in the difficult diagnosis of this anomaly.

          Related collections

          Most cited references11

          • Record: found
          • Abstract: found
          • Article: not found

          Management and outcomes of double aortic arch in 81 patients.

          Double aortic arch is a common form of complete vascular ring, encircling both the trachea and esophagus, resulting in noncardiac morbidity. We sought to describe management and outcomes in a large single institution clinical series. We reviewed the medical charts of all of the patients diagnosed with double aortic arch at age <18 years. Data regarding clinical presentation, anatomy, management, and outcomes were abstracted. We identified 81 patients (67% males) born between 1964 and 2005 and presenting at a median age of 5 months (range: birth to 10.3 years). Respiratory symptoms were present in 91%, including stridor in 77%. Gastrointestinal symptoms were present in 40%, with choking with feeds being most common. The dominant branch of the double aortic arch was right in 72%. Associated cardiac anomalies were present in 18%, with noncardiac anomalies in 7%. Repair was performed in 79 patients at a median age of 6 months. There were 2 deaths after surgical repair with no late deaths, with Kaplan-Meier survival estimates of 96% at 5 years. Postoperative complications included chylothorax in 9%. Only 1 patient required reoperation. The most common symptoms at most recent follow-up were respiratory (54%) followed by gastrointestinal symptoms (6%). Postoperative tracheal stenosis was documented in 14%, with tracheomalacia in 7%. There were no late reoperations and no evidence of aortic arch obstruction. Outcomes are excellent after repair of double aortic arch, although persistent respiratory symptoms are frequent and probably associated with previous compression-related maldevelopment of the trachea and major airways.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Vascular anomalies causing tracheoesophageal compression. Review of experience in children.

            Two hundred four infants and children (mean age 13 months) have undergone operation for the relief of tracheoesophageal obstruction resulting from vascular anomalies. One hundred thirteen patients had complete vascular rings (group I), 61 with double aortic arch and 52 with right aortic arch with a left ligamentum. Nine patients had a pulmonary artery sling (group II), 71 had innominate artery compression (group III), and 11 had miscellaneous anomalies (group IV). Patients were admitted with respiratory distress, stridor, apnea, dysphagia, or recurrent respiratory infections. Diagnosis was established by barium esophagogram in group I; barium esophagogram, bronchoscopy, and computed tomography or angiography in group II; bronchoscopy in group III; and barium esophagogram or angiography in group IV. The operative approach was through a left thoracotomy in group I, II and IV (93% of these patients) and through a right thoracotomy for group III (96% of these patients). The operative mortality rate was 4.9% and there were seven late deaths (3.4%). There have been no operative deaths in patients with isolated vascular anomalies in the past 28 years. Follow-up data from 1 month to 20 years (mean 8.5 months) were available on 159 patients; 141 (92%) were essentially free of symptoms, and 12 (8%) had residual respiratory problems. Five of six patients in group II having a lung scan postoperatively had a patent left pulmonary artery. A strong index of suspicion is necessary to avoid the complications of vascular rings in children. Barium swallow is the best single diagnostic technique for patients with complete vascular rings. A bronchoscopic study is required to diagnose innominate artery compression. Angiograms or computed tomographic scans are used to confirm the diagnosis of pulmonary artery sling. Left thoracotomy provides excellent exposure for all vascular rings except the displaced innominate artery, for which a right thoracotomy is the best approach.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Diagnosis and management of congenital vascular rings: a 22-year experience.

              Between 1968 and 1990, we operatively treated 39 patients (19 boys, 20 girls) with congenital aortic arch anomalies. Median age was 7 months (range, 1.5 months to 23 years). Thirty-seven patients (95%) had respiratory symptoms. Barium swallow was diagnostic in 95%. Right arch with aberrant left subclavian artery and double aortic arch were the most common types (11 each). Treatment of an aortic diverticulum was documented in 19 patients; the aortic diverticulum was excised (9), managed by aortopexy (7), or left in situ (3). Postoperative recovery was rapid, with a median intensive care unit stay of 2 days, time to oral feeding of 1 day, and postoperative time to discharge of 7 days. Two deaths occurred: 1 infant had undergone emergent operation for control of hemorrhage from an aortotracheal fistula due to tracheostomy tube erosion, and the other had multiple associated congenital heart defects. Postoperative complications included bleeding (1), pneumonia (5), and chylothorax (4). One boy had persistent severe symptoms due to an untreated aortic diverticulum and underwent subsequent excision of the aortic diverticulum with complete relief of symptoms. Median length of follow-up was 12.5 months, with at least 97% of survivors completely or nearly completely free of symptoms from the vascular ring. These results suggest that early repair of congenital aortic vascular rings, including fixating or excising an associated serious aortic diverticulum, is safe and effective and allows for normal tracheal growth.
                Bookmark

                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                10 August 2017
                2017
                : 27
                : 273
                Affiliations
                [1 ]Service de Pédiatrie, Hôpital Militaire Mohamed V, Rabat, Maroc
                Author notes
                [& ]Corresponding author: Sihame Lemouakni, Service de Pédiatrie, Hôpital Militaire Mohamed V, Rabat, Maroc
                Article
                PAMJ-27-273
                10.11604/pamj.2017.27.273.13481
                5660912
                29187942
                cfb528f9-0e71-43ed-9640-b8b963816cf5
                © Sihame Lemouakni et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 July 2017
                : 02 August 2017
                Categories
                Case Report

                Medicine
                double arc aortique,anneau vasculaire,stridor,double aortic arch,vascular ring
                Medicine
                double arc aortique, anneau vasculaire, stridor, double aortic arch, vascular ring

                Comments

                Comment on this article