Management of double aortic arch in children
Iranian Journal of Pediatric Surgery,
Vol. 2 No. 1 (2016),
23 August 2016
Introduction: Double aortic arch (DAA) is a rare congenital malformation. Strategies for diagnosis and treatment are different. Reports of thoracoscopic treatment of DAA are rare. We report a description of our diagnostic and therapeutic approach and evaluate outcomes.
Material & Methods: We reviewed charts of infants with double aortic arch who were hospitalized in our department from 2008 to 2014. Age at symptom onset, clinical presentation, diagnostic modality, operative details and post operative outcomes were retrieved.
Results: We identified 7 patients presenting at a median age of 11,8 months (range: 2 months-27 months) and median weight of 10kg. Respiratory symptoms were present in all cases. Difficulties in feedings were present in 3 cases. Chest radiography, oesophagogram and Computed Tomography (CT) with three-dimentional (3D) reconstructions were performed for all patients. One patient had laryngo tracheoscopy and 3 patients echocardiography. The dominant branch was the right one in all cases. Associated cardiac anomaly was found in 1 case. Operative approach was thoracotomy in 3 cases and thoracoscopic video assisted surgery (VATS) in 4 cases. Median operative time was 132 min. Only one patient required conversion. Median hospital stay was 4,1 days.
Conclusion: Double aortic arch is a rare malformation which can cause persistent non specific respiratory symptoms in infants. The use of 3D-CT scan reconstruction facilitates diagnosis and the operative approach. Thoracoscopy and thoracotomy are effective procedures even for patients with low body weight. The operative time seems similar for both approaches. Thoracoscopy offers less post-operative analgesia requirement, shorter hospital stay and good cosmetic results.
- double aortic arch
- vascular ring
How to Cite
- Al-Bassam A, Saquib Mallick M, Al-Qahtani A et al: Thoracoscopic division of vascular rings in infants and children. J Pediatr Surg. 2007; 42(8):1357–1361.
- Gross RE: Surgical relief for tracheal obstruction from a vascular ring. N Engl J Med 1945;233: 586.
- Hetal N Jeeyani, Vaishali J Prajapati, Nehal H Patel et al : Imaging features of double aortic arch shown by multi detector computed tomography angiography. Ann Pediatr Cardiol. 2010; 3(2): 169–170.
- Cerillo AG, Amoretti F, Moschetti R et al: Sixteen-row multislice computed tomography in infants with double aortic arch. Int J Cardiol. 2005; 99(2):191–4.
- Burke RP, Chang A: Video-assisted thoracoscopic division of a vascular ring in an infant: a new operative technique. J Card Surg. 1993; 8: 537 - 40.
- Alsenaidi K, Gurofsky R, Karamlou T, et al: Management and outcomes of double aortic arch in 81 patients. Pediatrics. 2006; 118(5): 1336-41.
- Ruzmetov M, Vijay P, Rodefeld MD et al: Follow-up of surgical correction of aortic arch anomalies causing tracheoesophageal compression: a 38-year single institution experience. J Pediatr Surg. 2009; 44:1328–1332
- Majid Y, Warade M, Aziz Z et al: Double aortic arches, esophageal atresia and tracheal compression. J Indian Assoc Pediatr Surg 2009;14(2):70-2.
- Bonnard A, Auber F, Fourcade L et al: Vascular rings abnormalities: a retrospective study of 62 cases. J pediatr surg 2003; 38(4):539-43.
- Shanmugam G, Macarthur K, Pollock J. Surgical Repair of Double Aortic Arch: 16-year Experience. Asian Cardiovasc Thorac Ann. 2005;13:4-10.
- Waters ET, Oberman JP, Biswas AK: Pierre Robin sequence and double aortic arch: a case report. Int J Pediatr Otorhinolaryngol. 2005;69:105-10.
- Sánchez Andrés A, Arenas Ramirez J, Rodriguez Fernández A: Anillo vascular completo: diagnóstico prenatal de doble arco aórtico. An Pediatr (Barc). 2014;81(4):260-2.
- Tuo G, Volpe P, Bava GL, et al: Prenatal diagnosis and outcome of isolated vascular rings. Am J Cardiol. 2009;103(3):416-9.
- Burke RP, Roscenfeld HM, Wernovsky G, et al: Video-assisted thoracoscopic division of vascular rings in 6 infants and children. J Am Coll Cardiol 1995;25:943 - 7.
- Abstract Viewed: 451 times
- PDF Downloaded: 298 times