Asymptomatic Balanced-Type Double Aortic Arch in an Elderly Patient: A Case Report

Abstract

Double aortic arch is a congenital abnormality and sporadic cases have been reported in adult patients, who are usually diagnosed after complaining of asthma-like symptoms or swallowing difficulties because of the compression of the trachea or esophagus by the abnormal aortic arches. We present the case of a 67-year-old male patient with double aortic arch, found coincidentally during coronary angiographic examination.

A Case of Balanced Type Double Aortic Arch Diagnosed Incidentally by Transthoracic Echocardiography in an Asymptomatic Adult Patient

“…Double aortic arch (DAA) is a congenital anomaly, which is formed from the dividing of the ascending aorta into two limbs that pass around the trachea and esophagus, then enter a single descending aorta 1)2). In most cases, this anomaly can be diagnosed during infancy or childhood due to symptoms caused by esophageal or tracheal obstruction.…”

Double aortic arch in an adult undergoing coronary bypass surgery: a therapeutic dilemma?

“…The severity of symptoms depends on the severity of compression of the structures (trachea, esophagus) within the vascular ring. However, when compression is minimal, DAA can go undiagnosed into adulthood [1][2][3][4].…”

“…However, a therapeutic dilemma exists when asymptomatic patients undergo surgery for another cardiac condition. To date, there are only a handful of case reports that describe asymptomatic DAA diagnosed in the 6th and 7th decades of life [1][2][3][4]. All four patients were treated conservatively, even in one undergoing coronary bypass surgery [1].…”

“…The standard of care is unclear due to the rarity of this finding in adults. Recent reports document non-operative management [2][3][4] even in a patient undergoing coronary bypass surgery [1] with good results. Most probably, had we elected not to proceed with division of the DAA, the patient would have recovered uneventfully.…”

“…Usually, this causes significant symptoms and patients are diagnosed and treated early in life. However, sporadic cases [1][2][3][4][5] have been reported in adults. We describe the treatment of an asymptomatic adult who was found to have DAA during his workup for coronary artery disease.…”