Congenital anomalies of the aortic arch

Abstract

Congenital anomalies of the aortic arch include diverse subgroups of malformations that may be clinically silent or may present with severe respiratory or esophageal symptoms especially when associated with complete vascular rings. These anomalies may be isolated or may be associated with other congenital heart diseases. Volume rendered computed tomography (CT) and magnetic resonance angiography (MRA) help in preoperative surgical planning by providing information about the complex relationship of aortic arch and its branches to the trachea and esophagus. Three dimensional capabilities of both computed tomography angiography (CTA) and MRA are helpful in determining evidence of tracheal or esophageal compression or other high-risk features in patients with a complete vascular ring.

Imaging of the aortic root on high-pitch non-gated and ECG-gated CT: awareness is the key!

“…The accuracy and hence use of CTA for other vascular applications like coronary artery imaging is also expanding [11]. CT is fast, noninvasive, widely available, and allows evaluation of entire aorta with very high (nearly 100%) sensitivity and specificity for the diagnosis of aortic pathologies [2,4,12]. CT imaging of the proximal aorta requires appropriate timing for peak aortic contrast enhancement and conventionally needs ECG gating to prevent artifacts from transmission of cardiac pulsations.…”

“…These advances are mostly driven by faster gantry rotations, faster table speed, and sometimes by the use of more than one X-ray source, allowing high-pitch exams. Such highpitch CT scans have allowed aortic evaluation even without ECG gating [3][4][5]. The high-pitch scans are being increasingly used for non-aortic clinical indications because of lack of motion (both breathing and pulsation) artifacts as well as decreased radiation dose [3].…”

Reduced maternal vitamin A status increases the incidence of normal aortic arch variants

“…This variant is often referred to as a "bovine arch" because of similarities to the aortic arch of cattle; however, it is not a true bovine arch since in cattle the origin of the left subclavian and the left and right carotid arteries is from a single brachiocephalic trunk (Moorehead et al, 2016;Spacek & Veselka, 2012;Stewart, 1964). While anatomic variants of the aortic arch are often considered clinically insignificant, variants can be associated with clinically significant cardiac malformations or interfere with respiration and swallowing (Carucci & Turner, 2015;Poletto, Mallon, Stevens, & Avitabile, 2017;Priya, Thomas, Nagpal, Sharma, & Steigner, 2018;Stewart, 1964;Wells, Landing, & Shankle, 1993). The bovine arch variant in particular is associated with an increased risk for thoracic aortic aneurysm (Priya et al, 2018;Toya et al, 2018).…”

“…While anatomic variants of the aortic arch are often considered clinically insignificant, variants can be associated with clinically significant cardiac malformations or interfere with respiration and swallowing (Carucci & Turner, 2015;Poletto, Mallon, Stevens, & Avitabile, 2017;Priya, Thomas, Nagpal, Sharma, & Steigner, 2018;Stewart, 1964;Wells, Landing, & Shankle, 1993). The bovine arch variant in particular is associated with an increased risk for thoracic aortic aneurysm (Priya et al, 2018;Toya et al, 2018). Benign aortic arch abnormalities can also contribute to complications during surgical interventions (Hanneman, Newman, & Chan, 2017;Natsis et al, 2009).…”

“…The most prevalent variant involves a in loss of the transverse arch so that the brachiocephalic and left common carotid arteries share a common origin and occurs in 10-20% of the population (Moorehead et al, 2016;Spacek & Veselka, 2012;Stewart, 1964). While anatomic variants of the aortic arch are often considered clinically insignificant, variants can be associated with clinically significant cardiac malformations or interfere with respiration and swallowing (Carucci & Turner, 2015;Poletto, Mallon, Stevens, & Avitabile, 2017;Priya, Thomas, Nagpal, Sharma, & Steigner, 2018;Stewart, 1964;Wells, Landing, & Shankle, 1993). While anatomic variants of the aortic arch are often considered clinically insignificant, variants can be associated with clinically significant cardiac malformations or interfere with respiration and swallowing (Carucci & Turner, 2015;Poletto, Mallon, Stevens, & Avitabile, 2017;Priya, Thomas, Nagpal, Sharma, & Steigner, 2018;Stewart, 1964;Wells, Landing, & Shankle, 1993).…”