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Baudo M, Sicouri S, Yamashita Y, Senzai M, Herman CR, Rodriguez R, Patel S, Ahmal B, Lo Rito M, Meisner R, Hirsch L, Uribe A, Ramlawi B. Clinical Presentation and Management of the Cervical Aortic Arch in the Adult Population: A Review of Case Reports. J Cardiothorac Vasc Anesth 2024; 38:1777-1785. [PMID: 38834445 DOI: 10.1053/j.jvca.2024.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 06/06/2024]
Abstract
The cervical aortic arch (CAA) is an uncommon congenital anomaly in aortic development, characterized by an elongated aortic arch extending at or above the medial ends of the clavicles. Our objective was to examine the clinical and surgical characteristics of this infrequent condition in the adult population. PubMed, ScienceDirect, SciELO, DOAJ, and Cochrane Library databases were searched until December 2023 for case reports describing the presence of a cervical aortic arch in patients aged ≥18 years. Case reports and series were included if the following criteria were met: (1) description of the cervical aortic arch, (2) age ≥18 years, and (3) English language. The literature search identified 2,325 potentially eligible articles, 61 of whom met our inclusion criteria and included a combined number of 71 patients. Mean age was 38.6 ± 15.4 years, with a female prevalence of 67.1% (47/70). Two-thirds of the CAA were left-sided (48/71, 67.6%), and 62.0% (44/71) of patients presented a concomitant arch aneurysm. Asymptomatic patients were 45.7% (32/70), while of those that were symptomatic, 60.5% (23/38) had symptoms related to vascular-induced compression of trachea and esophagus. Surgery was performed in 42 patients (62.7%) among 67 cases that reported the patient's treatment, and 5 patients (11.9%) among those surgically treated underwent the procedure through an endovascular approach. CAA is an uncommon congenital abnormality that presents challenges in diagnosis and treatment due to its high anatomical variability, diverse clinical manifestations, and presence of concomitant diseases. Surgery seems to be a safe and effective option for the resolution of symptoms.
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Affiliation(s)
- Massimo Baudo
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA; Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA.
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA
| | - Yoshiyuki Yamashita
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA; Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Mikiko Senzai
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA; Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Corey R Herman
- Department of Anesthesiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Roberto Rodriguez
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Shalin Patel
- Department of Anesthesiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Bilal Ahmal
- Department of Anesthesiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Robert Meisner
- Division of Vascular Surgery, Department of Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Lior Hirsch
- Division of Vascular Surgery, Department of Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Alexander Uribe
- Division of Vascular Surgery, Department of Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Basel Ramlawi
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA; Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
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Baudo M, Varrica A, Reali M, Saracino A, Carminati M, Frigiola A, Giamberti A, Lo Rito M. Cervical aortic arch in the pediatric population: a meta-analysis of individual patient's data. Front Cardiovasc Med 2023; 10:1266956. [PMID: 37855019 PMCID: PMC10580808 DOI: 10.3389/fcvm.2023.1266956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023] Open
Abstract
Background This is the first meta-analysis to analyze all reports of published pediatric cases of cervical aortic arch (CAA) by highlighting the clinical characteristics and treatment outcomes using the reported individual data of the patients. The aim of the study is to investigate the clinical features and surgical outcomes of such a rare disease in the pediatric population. Methods A comprehensive search was conducted in various academic databases, including PubMed, ScienceDirect, SciELO, DOAJ, and Cochrane Library, until June 2022 for case reports describing the presence of cervical aortic arch in the pediatric age. Case reports and series were included if the following criteria were met: (1) description of the cervical aortic arch; (2) patient of pediatric age; and (3) published in the English language. All other types of publications that lacked patient-specific information were excluded from the analysis. This systematic review was conducted in accordance with the PRISMA guidelines. The primary outcome measure of the analysis was early and late mortality. Results The literature search identified 2,272 potentially eligible articles, 72 of which met our inclusion criteria with 96 patients including the author's institutional case. At a median of 365 (90-730) days, the overall cohort registered a 7.3% (7/96) mortality rate. In the subset of patients who underwent surgery, the mortality rate was also 7.3% (4/55), and the mortality rate following surgery to treat only CAA was 2.4% (1/42). Dyspnea was identified as an independent determinant of mortality by employing the univariable Firth bias-reduced logistic regression method. Conclusion Cervical aortic arch is a rare congenital heart disease that poses treatment challenges due to the high anatomical variability, diverse clinical presentations, and the presence of other concomitant diseases. The surgical treatment appears to be a safe and effective approach for resolving the symptoms, although it needs to be tailored individually for each patient. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346826, Identifier: CRD42022346826.
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Affiliation(s)
- Massimo Baudo
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alessandro Varrica
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Matteo Reali
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonio Saracino
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mario Carminati
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Ramaswamy P, Harrington JK. Fetal echocardiographic diagnosis of a triad with common embryological origins: Cervical aortic arch, retro-aortic left innominate vein and coarctation of the aorta. Echocardiography 2021; 38:1657-1661. [PMID: 34510548 DOI: 10.1111/echo.15179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/17/2021] [Accepted: 08/06/2021] [Indexed: 11/27/2022] Open
Abstract
Cervical aortic arch (CAA) and retro-aortic innominate vein (RAIV) are rare entities which can be associated with one another in a structurally normal heart. Less well recognized is the fact, that a third entity may often be present as well, since aortic arch abnormalities are common in a CAA. Hence, these three entities (CAA, RAIV, and an arch anomaly - in this case a post-ductal coarctation) may present as a triad. We present the first prenatal diagnosis of this rare triad which can be explained by common embryological origins which are discussed along with instructive aspects in diagnosis and management.
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Affiliation(s)
- Prema Ramaswamy
- Department of Pediatrics, Division of Pediatric Cardiology, Maimonides Children's Hospital, Brooklyn, New York, USA
| | - Jamie K Harrington
- Department of Pediatrics, Division of Pediatric Cardiology, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
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Mantri SS, Raju B, Jumah F, Rallo MS, Nagaraj A, Khandelwal P, Roychowdhury S, Kung D, Nanda A, Gupta G. Aortic arch anomalies, embryology and their relevance in neuro-interventional surgery and stroke: A review. Interv Neuroradiol 2021; 28:489-498. [PMID: 34516323 PMCID: PMC9326868 DOI: 10.1177/15910199211039924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Congenital aortic arch anomalies are commonly encountered during neurointerventional procedures. While some anomalies are identified at an early age, many are incidentally discovered later in adulthood during endovascular evaluations or interventions. Proper understanding of the normal arch anatomy and its variants is pivotal to safely navigate normal aortic arch branches and to negotiate the catheter through anomalies during neurointerventional procedures. This is particularly relevant in the increasingly "transradial first" culture of neurointerventional surgery. Moreover, some of these anomalies have a peculiar predilection for complications including aneurysm formation, dissection, and rupture during the procedure. Therefore, an understanding of these anomalies, their underlying embryological basis and associations, and pattern of circulation will help endovascular neurosurgeons and interventional radiologists navigate with confidence and consider relevant pathologic associations that may inform risk of cerebrovascular disease. METHODS Here, we present a brief review of the basic embryology of the common anomalies of the aortic arch along with their neurological significances and discuss, through illustrative cases, the association of aortic arch anomalies with cerebral vascular pathology. CONCLUSIONS Understanding the aortic arch anomalies and its embryological basis is essential to safely navigate the cerebral vascular system during neurointerventional surgeries.
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Affiliation(s)
- Shilpa S Mantri
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Bharath Raju
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Fareed Jumah
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Michael S Rallo
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Anmol Nagaraj
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, 242612New Jersey Medical School & University Hospital, USA
| | - Sudipta Roychowdhury
- Department of Neuroradiology, 12287 Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - David Kung
- Department of Neurosurgery, 242612New Jersey Medical School & University Hospital, USA
| | - Anil Nanda
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Gaurav Gupta
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
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Jhaveri S, Komarlu R. Prenatal diagnosis of right-sided cervical aortic arch with aberrant left subclavian artery and absent ductus arteriosus in tetralogy of Fallot. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:414-416. [PMID: 30338597 DOI: 10.1002/uog.20151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Affiliation(s)
- S Jhaveri
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - R Komarlu
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, USA
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Shayan G, Shao J, Wang Y, Si L, Shen J, Chen Y, Liu B, Zheng Y. Management of cervical aortic arch complicated by multiple aneurysms. Interact Cardiovasc Thorac Surg 2019; 29:295–301. [PMID: 30903156 DOI: 10.1093/icvts/ivz087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Cervical aortic arch with aneurysm formation is considered an extremely rare condition. Here, we summarize our experience in treating 8 patients. We validated extra-anatomic ascending-to-infrarenal abdominal aorta bypass through the retroperitoneal cavity without circulatory arrest as an alternative treatment for patients with a tortuous arch that was unsuitable for endovascular repair. METHODS From March 2015 to April 2018, 8 patients (7 women; median age 46 years) diagnosed with cervical aortic arch complicated with aneurysm formation were treated at Peking Union Medical College Hospital and the Affiliated Hospital of Qingdao University. After assessment of the anatomical characteristics, 4 patients underwent endovascular repair. Three patients with a tortuous aortic arch and saccular aneurysm formation between the left common carotid artery and the left subclavian artery were treated with an extra-anatomic ascending-to-infrarenal abdominal aorta bypass and aneurysm indwelling. One patient refused surgical intervention and is being followed up on a yearly basis at our outpatient clinic. No circulatory arrest was required during surgery. RESULTS No severe postoperative complications were observed during follow-up (6-36 months). Postoperative computed tomography angiography revealed patent blood flow in the prosthetic aortic graft bypass. No endoleak, migration or stenosis of the stent grafts was observed in patients following endovascular repair. The left subclavian artery was preserved in 3 patients. Follow-up computed tomography angiography revealed satisfactory postoperative results in all patients, with no signs of aortic dilation or coarctation. CONCLUSIONS Ascending-to-infrarenal abdominal aorta bypass through the retroperitoneal cavity is a safe and effective treatment for cervical aortic arch with a tortuous aorta complicated by aneurysm formation and coarctation.
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Affiliation(s)
- Gulidanna Shayan
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China.,School of Medicine, Tsinghua University, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
| | - Yuewei Wang
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Loubin Si
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
| | - Junyue Shen
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China.,School of Medicine, Tsinghua University, Beijing, China
| | - Yu Chen
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
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Zhong YL, Ma WG, Zhu JM, Qiao ZY, Zheng J, Liu YM, Sun LZ. Surgical repair of cervical aortic arch: An alternative classification scheme based on experience in 35 patients. J Thorac Cardiovasc Surg 2019; 159:2202-2213.e4. [PMID: 31376997 DOI: 10.1016/j.jtcvs.2019.03.143] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cervical aortic arch (CAA) is rare and difficult to repair. Clinical experience is limited. We report the surgical techniques and midterm outcomes in 35 patients with CAA based on an alternative classification scheme. METHODS Of 35 patients with CAA, 30 (85.7%) had left-sided aortic arch and 5 had (14.3%) right-sided aortic arch (all 5 had a vascular ring). Mean age was 34.2 ± 13.1 years, 23 were female (65.7%), and 18 were asymptomatic (51.4%). Surgical access and procedure were chosen according to an alternative classification scheme that is based on the presence or absence of vascular ring and relationship of descending aorta to the side of the aortic arch. In the left-sided aortic arch group, aortic arch reconstruction though median sternotomy was performed in 15 patients, and distal arch and descending thoracic aortic replacement via left thoracotomy in 15 patients. In the right-sided aortic arch group, ascending-to-descending aortic bypass was done via median sternotomy in 2 patients and right thoracotomy in 1, and distal arch and descending thoracic aortic replacement via right thoracotomy in 2 patients. RESULTS Neither death nor spinal cord injury occurred. Left recurrent laryngeal nerve injury, prolonged ventilation, and reexploration for bleeding occurred in 1 each. In 11 patients with coarctation, the upper-lower limb gradient decreased significantly postoperatively (from 34.0 ± 12.7 to 10.2 ± 2.7 mm Hg; P < .01). The diseased aortic segment was excluded in 34 patients, except 1 with residual aneurysm in the proximal descending thoracic aorta. Follow-up was complete in 100% at mean 4.4 ± 2.0 years. No late death, limb ischemia, or stroke occurred. Endovascular repair was performed in 1 patient, and ascending aortic dilation occurred in 1 patient. The residual aorta remained nondilated in 33 patients. Aortic grafts were patent in 100%, with no anastomotic leak or pseudoaneurysm. At 6 years, the incidences of death, aortic events, and event-free survival were 0%, 6.5%, and 93.5%, respectively. CONCLUSIONS Open repair of CAA can achieve favorable early and midterm outcomes. Surgical accesses and procedures should be chosen based on type of CAA, anatomic variations and associated anomalies. Our alternative categorization scheme of CAA is intuitive and comprehensive, which may facilitate classification and surgical decision making.
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Affiliation(s)
- Yong-Liang Zhong
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Wei-Guo Ma
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Jun-Ming Zhu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China.
| | - Zhi-Yu Qiao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Jun Zheng
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Yong-Min Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
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Hanneman K, Newman B, Chan F. Congenital Variants and Anomalies of the Aortic Arch. Radiographics 2017; 37:32-51. [DOI: 10.1148/rg.2017160033] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
We present a rare case of cervical aortic arch with associated spontaneously ruptured thoracic aortic aneurysm. Our case is unique in that the apex of the arch was at the level of the second cervical vertebra, the most cranial location of all reported cases. To our knowledge, this case represents the first "oropharyngeal cervical aortic arch" ever described. We will briefly discuss the embryology of the normal thoracic aorta and the postulated embryology of the cervical aortic arch. We will describe the Haughton classification of cervical aortic arches and discuss typical associated conditions, emphasizing the key findings in these complex anomalies.
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Momma K. Cardiovascular anomalies associated with chromosome 22q11.2 deletion syndrome. Am J Cardiol 2010; 105:1617-24. [PMID: 20494672 DOI: 10.1016/j.amjcard.2010.01.333] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 01/05/2010] [Accepted: 01/05/2010] [Indexed: 11/30/2022]
Abstract
Cardiovascular anomalies are present in 80% of neonates with 22q11.2 deletion syndrome. Three genes in chromosome 22q11.2 (TBX1, CRKL, and ERK2) have been identified whose haploinsufficiency causes dysfunction of the neural crest cell and anterior heart field and anomalies of 22q11.2 deletion syndrome. The most common diseases are conotruncal anomalies, which include tetralogy of Fallot (TF), TF with pulmonary atresia, truncus arteriosus, and interrupted aortic arch. A high prevalence of the deletion is noted in patients with TF with absent pulmonary valve, TF associated with pulmonary atresia and major aortopulmonary collateral arteries, truncus arteriosus, and type B interruption of aortic arch. Right aortic arch, aberrant subclavian artery, cervical origin of the subclavian artery, crossing pulmonary arteries, and major aortopulmonary collateral arteries are frequently associated with cardiovascular anomalies associated with 22q11.2 deletion syndrome. Virtually every type of congenital heart defect has been described early in the context of a 22q11.2 deletion. In conclusion, conotruncal anomaly associated with aortic arch and ductus arteriosus anomalies should increase the suspicion of 22q11.2 deletion.
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Affiliation(s)
- Kazuo Momma
- Section of Pediatric Cardiology, Heart Center, Tokyo Women's Medical University, Tokyo, Japan.
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Left-sided Cervical Aortic Arch Associated With Pseudocoarctation, Aneurysm Formation, and Anomalous Left Brachiocephalic Vein. J Thorac Imaging 2008; 23:206-9. [DOI: 10.1097/rti.0b013e318178829c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Mitsumori Y, Tsuchiya K, Nakajima M, Fukuda S, Morimoto H. Surgical repair of left-sided cervical aortic arch aneurysm: case report and literature review. Ann Vasc Surg 2008; 22:140-4. [PMID: 18191070 DOI: 10.1016/j.avsg.2007.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Revised: 06/19/2007] [Accepted: 07/23/2007] [Indexed: 10/21/2022]
Abstract
Cervical aortic arch (CAA) is a rare vascular malformation which sometimes accompanies other cardiovascular malformations. Surgical approaches such as a lateral thoracotomy and a median sternotomy are selected depending on the position and type of aneurysm and other associated malformations. We herein report the case of a CAA patient who was a 38-year-old female and demonstrated an aneurysm between the left common carotid artery and left subclavian artery in addition to the persistence of the left superior vena cava (PLSVC). During surgery, the aortic arch from the distal right brachiocephalic trunk bifurcation to the proximal left subclavian artery bifurcation was replaced with a prosthetic graft to reconstruct the left common carotid artery. The median sternotomy approach was selected. Hypothermic circulatory arrest was performed using a cardiopulmonary bypass (CPB), and anterograde cerebral perfusion was conducted from the brachiocephalic trunk. The patient was discharged from the hospital without any complications 16 days after surgery. Magnetic resonance angiography was useful for diagnosing the precise position of the aneurysm. When encountering an aneurysm associated with the CAA in the transverse aortic arch or PLSVC, the median sternotomy approach is considered the treatment of choice.
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Affiliation(s)
- Yoshitaka Mitsumori
- Department of Cardiovascular Surgery, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
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Baravelli M, Borghi A, Rogiani S, Preda L, Quattrociocchi M, Fantoni C, Crupi G, Tiraboschi R. Clinical, anatomopathological and genetic pattern of 10 patients with cervical aortic arch. Int J Cardiol 2007; 114:236-40. [DOI: 10.1016/j.ijcard.2005.12.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2005] [Revised: 11/14/2005] [Accepted: 12/07/2005] [Indexed: 10/24/2022]
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14
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Affiliation(s)
- Roberto Lorusso
- Cardiac Surgery Division, Civic Hospital, Piazzale Spedali Civili 1, Brescia, Italy.
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15
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Affiliation(s)
- Kazuhiko Higuchi
- Department of Cardiac Surgery, Asahi General Hospital, Chiba, Japan.
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Abstract
BACKGROUND The Jing-Mai (variously translated as the Channel, Vessel or Meridians), as described by traditional Chinese medicine, probably exists and has represented the connections between various parts of human body during embryonic development. According to the Chinese theories, there are 14 major Jing-Mai within the human body, of which four are directly connected with the Heart. METHODS The described paths of the four Jing-Mai were compared with features of congenital syndromes involving particular types of congenital heart defects. RESULTS Specific correlation seem to exist between such four Jing-Mai and known developmental mechanisms underlying various congenital heart defects: the Kidney Jing-Mai-ectomesenchymal tissue migration abnormalities; the Spleen Jing-Mai-situs and looping defects; the Heart Jing-Mai-abnormal cell death; the Small Intestine Jing-Mai (and the Heart Jing-Mai)-extracellular matrix anomalies. CONCLUSIONS The Chinese theories seem to provide some intriguing insights into the pathogeneses of congenital heart defects. The Jing-Mai seems to distinguish from, but nevertheless have a close relationship with the blood vessels. Utilization of the Jing-Mai will probably enable a better understanding and development of new treatments for cardiovascular diseases.
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Cuneo BF. In utero evaluation of velocardiofacial syndrome. PROGRESS IN PEDIATRIC CARDIOLOGY 2002. [DOI: 10.1016/s1058-9813(02)00039-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Eapen RS, Eidem BW. Echocardiographic assessment of velocardiofacial syndrome. PROGRESS IN PEDIATRIC CARDIOLOGY 2002. [DOI: 10.1016/s1058-9813(02)00037-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Marino B, Digilio M, Toscano A. Common arterial trunk, DiGeorge syndrome and microdeletion 22q11. PROGRESS IN PEDIATRIC CARDIOLOGY 2002. [DOI: 10.1016/s1058-9813(02)00004-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Endothelial dysfunction and changes in arterial wall morphology including thickening of the tunica intima, excess synthesis of collagenous matrix (fibroblastic intimal thickening) and permanent or dynamic deposition of lipids (fatty streaks) already occur in childhood or adolescence. Definite atherosclerotic plaques in the carotid arteries usually do not manifest themselves before menopause in women or age 40 in men. Obviously, cumulative (long-term) and excessive exposure of the vessel wall to risk factors is required to overcome highly effective defense mechanisms which have not yet been fully investigated. Initiation and early progression of atherosclerosis rely on conventional vascular risk factors such as hyperlipidemia, hypertension, smoking, severe alcohol consumption and chronic infections. Plaque extension is effectively compensated by a focal widening of the vessel, thereby preventing the development of lumen obstruction (vascular remodeling). For stenosis to emerge conventional plaques must convert to complicated plaques characterized by plaque rupture and consecutive atherothrombosis. This process usually starts with small- to medium-sized plaques. Potential determinants of plaque rupture are the composition of the lesion (large lipid-rich core), damage of the fibrous cap (destabilization by chronic inflammation) and hemodynamic stress. According to pathological observations, fissuring of atherosclerotic lesions is a frequent event, while the formation of overlying large thrombi (with progression of stenosis or vessel occlusion) is definitely rare. This conjecture emphasizes the significance of local and systemic thrombus-promoting factors. Actually, the risk profile of advanced atherogenesis in the Bruneck Study was primarily composed of markers of enhanced prothrombotic capacity, attenuated fibrinolysis and clinical conditions known to interfere with coagulation. Almost all subjects with > or =3 procoagulant risk conditions developed carotid stenosis or showed progression of preexisting stenosis during a 5-year period. Increasing insights into the complex biology of arterial atheroma and awareness of the etiologic peculiarities of advanced complicated plaques may serve as a basis for identifying high-risk subjects and for novel vascular prevention strategies with focus on plaque stabilization and antithrombotic/anticoagulant measures.
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Affiliation(s)
- J Willeit
- Department of Neurology, Innsbruck University Clinic, Innsbruck, Austria.
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21
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McElhinney DB, Thompson LD, Weinberg PM, Jue KL, Hanley FL. Surgical approach to complicated cervical aortic arch: anatomic, developmental, and surgical considerations. Cardiol Young 2000; 10:212-9. [PMID: 10824901 DOI: 10.1017/s1047951100009136] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Abnormalities of brachiocephalic arterial branching and arch laterality are common in patients with a cervical aortic arch. In addition, structural anomalies of the arch such as obstruction, aneurysms, and tortuosity are found in a significant number of cases. METHODS Between 1990 and 1998, 6 patients underwent surgery for an obstructed right cervical arch. A significant obstruction was present at the transverse or distal arch in all patients, and was recurrent after previous repair in 2. In 1 patient, there was also a multi-lobed aneurysm of the aortic segment contiguous to the obstruction, and in 2 there was marked tortuosity of the arch. In all cases, the order of origin of the head and neck vessels was abnormal, and obstruction of 1 or more brachiocephalic vessels was found in 3. A vascular ring was present in all patients, with a right aortic arch and aberrant left subclavian artery in 4 patients and a double aortic arch with a dominant right cervical arch in 2. The descending aorta was circumflex (left-sided) in 3 patients. Three patients were repaired through a standard right posterolateral thoracotomy, and 3 through a median sternotomy. Patch augmentation aortoplasty was used in 2 patients, a tube graft from the ascending to descending aorta in 2, end to side anastomosis of the descending aorta to the proximal arch in 1, and direct anastomosis to reconstruct an atretic left-sided component of a double arch in 1. RESULTS Repair was successful in all cases, with no perioperative complications. At follow-up ranging from 1 to 9 years, all patients were alive and well, with no recurrence of arch obstruction or other significant complications. Fluorescent in situ hybridization revealed microdeletion of chromosome 22q11 in 1 patient (not performed in the others). CONCLUSIONS Structural anomalies of the arch are relatively common in patients with a cervical aortic arch. Such abnormalities may be the result of hemodynamic conditions and/or abnormal vascular tissue related either to the cervical position of the arch or its embryologic precursors. Given the highly variable anatomy of patients with a complicated cervical aortic arch, surgical considerations will vary in kind.
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Affiliation(s)
- D B McElhinney
- Division of Cardiothoracic Surgery, University of California, San Francisco, USA
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22
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Abstract
BACKGROUND In the setting of normal cardiac situs, a right-sided aortic arch is uncommon. When a right arch does occur, it is typically in conjunction with other congenital cardiovascular anomalies, especially defects with abnormal right ventricular outflow. Congenital obstruction of a right arch, caused by coarctation, interruption, or cervical arch, is extremely rare. METHODS We reviewed our experience and all reported cases of right aortic arch with coarctation of the aorta, interrupted arch, or obstruction of a cervical arch in the setting of normal cardiac situs and topology. RESULTS Since 1992, 4 such patients have undergone repair at our institution, including 1 with interrupted arch, 1 with coarctation of a mirror image arch, and 2 with obstruction of a cervical arch. In addition to these 4 patients, 38 others have been described in the published reports: 15 with interrupted arch, 19 with coarctation, and 4 with obstruction of a cervical arch. Associated cardiac defects were uncommon, except for ventricular septal defect in patients with interrupted arch, but abnormalities of the brachiocephalic vessels were frequent. Except for most of the patients with interrupted right arch, the majority of patients described have undergone successful surgical repair. CONCLUSIONS Although obstructive arch lesions are often grouped together, the etiologies of coarctation of the aorta, interrupted arch, and cervical arch with obstruction almost certainly differ. The rarity of such lesions among patients with right aortic arch may be explained in part by the fact that the fetal hemodynamic conditions associated with persistence of a right arch do not facilitate flow-related arch obstruction. In this review, we discuss these issues in detail, along with specific surgical considerations in the management of obstruction lesions of the right aortic arch.
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Affiliation(s)
- D B McElhinney
- Division of Cardiothoracic Surgery, University of California, San Francisco, USA
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23
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Abstract
Cervical aortic arch is a developmental entity consisting of persistence of the right or left third branchial arch and regression of the fourth branchial arches. In most cases, the aorta is redundant and crosses behind the esophagus to the opposite side. In the presence of an aberrant subclavian artery contralateral to the side of the aortic arch and a ligamentum arteriosum, a vascular ring is formed around the trachea and esophagus. Two young patients with right-sided cervical aortic arch, aberrant left subclavian artery, and ligamentum arteriosum presented with dysphagia and exertional dyspnea. In one patient, through a left thoracotomy, the ligamentum arteriosum was divided, and the trachea and esophagus were dissected thoroughly above and below the level of the ring. In addition, the aberrant left subclavian artery was divided at its origin from a large diverticulum and implanted into the left common carotid artery; the aortic diverticulum was resected. In the other patient, who had associated 22q11 chromosomal deletion, in addition to left-sided compression of the trachea and esophagus, there was additional marked compression of the right anterolateral trachea by the redundant ascending aorta. Through a median sternotomy, the ligamentum arteriosum was divided, and the trachea and esophagus were widely mobilized; an additional aortopexy of the ascending aorta to the right of the sternum resulted in the absence of tracheal compression. The cases of the two reported patients illustrate the clinical variability of vascular ring, including a right cervical aortic arch and the consequently versatile surgical approach that is needed to successfully address this combination of vascular anomalies.
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Affiliation(s)
- J A van Son
- Department of Cardiac Surgery, Herzzentrum, University of Leipzig, Germany
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24
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Abstract
A 23-year-old man presented with hypotension secondary to a left hemothorax. Diagnostic studies revealed a left cervical arch associated with a redundant tortuous pseudocoarctation in the proximal descending thoracic aorta. Operative exploration revealed an aortic rupture just proximal to the pseudocoarctation. Resection of the diseased aorta and tube graft replacement was performed under circulatory arrest. The patient was discharged home on the 12th postoperative day.
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Affiliation(s)
- J S Ikonomidis
- Department of Cardiothoracic Surgery, Stanford Health Services, California 94305-5247, USA
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Son JAM, Bossert T, Mohr FW. Surgical Treatment of Vascular Ring Including Right Cervical Aortic Arch. Echocardiography 1985. [DOI: 10.1111/j.1540-8175.1985.tb01254.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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