‘Bovine’ Aortic Arch – A Marker for Thoracic Aortic Disease

Abstract

Objectives: Very few studies have addressed the clinical significance of ‘bovine’ aortic arch (BA). We sought to determine whether BA is associated with thoracic aortic disease, including thoracic aortic aneurysm, aortic dissection, aortic rupture, and accelerated aortic growth rate. Methods: We retrospectively reviewed CT and/or MRI scans of 612 patients with thoracic aortic disease and 844 patients without thoracic aortic disease to determine BA prevalence. In patients with thoracic aortic disease, we reviewed hospital records to determine growth rate, prevalence of dissection and rupture, and accuracy of radiology reports in citing BA. Results: 26.3% of the patients with thoracic aortic disease had concomitant BA, compared to 16.4% of the patients without thoracic aortic disease (p < 0.001). There was no association between BA and prevalence of dissection or rupture (p = 0.38 and p = 0.56, respectively). The aortic expansion rate was 0.29 cm/year in the BA group and 0.09 cm/year in the non-BA group (p = 0.004). Radiology reports cited BA in only 16.1% of the affected patients. Conclusions: (1) BA is significantly more common in patients with thoracic aortic disease than in the general population. (2) Aortas expand more rapidly in the setting of BA. (3) Radiology reports often overlook BA. (4) BA should not be considered a ‘normal’ anatomic variant.

Biomechanical characterization of ascending aortic aneurysm with concomitant bicuspid aortic valve and bovine aortic arch

“…More recently, a link between bovine aortic arch anatomy and thoracic aortic aneurysms has also been suggested [9]. In the majority of patients (74%), there are three great vessels branching from the aortic arch: the innominate artery, the left carotid artery, and the left subclavian artery [10].…”

Patient-specific finite element analysis of ascending aorta aneurysms

“…Patients with concomitant bicuspid aortic valve (BAV) and bovine aortic arch (BAA) were studied specifically to gain a better understanding of why these patients may be more susceptible to AsAA and dissection (10,14,42). BAV and BAA are common congenital malformations of the aortic anatomy.…”

Bovine Aortic Arch: Normal Variant or a Marker of Aortopathy?

“…In this issue of Cardiology, Hornick et al [7] suggest that the bovine aortic arch may be a ‘marker of thoracic aortic disease’. The authors retrospectively analyzed chest computed tomography and magnetic resonance imaging studies in 612 patients who were evaluated at the Aortic Institute at Yale-New Haven Hospital, New Haven, Conn., USA, between 2003 and 2010.…”

“…The authors suggested that focal aortic fragility possibly related to abnormal hemodynamics in the bovine aortic arch was responsible for these findings. Hornick et al [7] demonstrated a higher aortic growth rate in the descending thoracic aorta in patients with aortic disease and a bovine aortic arch. The precise underlying molecular-pathophysiologic mechanism for these abnormalities remained to be defined.…”