This Article Full Text (PDF) Movie Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Brockmeier, Articles by Floemer, Search for Related Content PubMed PubMed Citation Articles by Brockmeier, Articles by Floemer, Related Collections Cardiovascular imaging agents/Techniques CT and MRI

(Circulation. 2000;102:e93.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Double Aortic Arch

Konrad Brockmeier, MD; Sueha Demirakca, MD; Roland Metzner, MD; Frank Floemer, MD

From the Department of Pediatric Cardiology, University Hospital of Heidelberg (K.B.), Heidelberg; the Department of Pediatrics, University Hospital of Mannheim (S.D.), Mannheim; and the Department of Radiology, German Cancer Research Center (R.M., F.F.), Heidelberg, Germany.

Correspondence to Konrad Brockmeier, MD, Department of Pediatric Cardiology, University Hospital, INF 153, 69120 Heidelberg, Germany. E-mail konrad_brockmeier{at}med.uni-heidelberg.de

A7-year-old girl presented with severe dyspnea and pneumonia, which required endotracheal intubation, mechanical ventilation, and intravenous antibiotics. She had a history of several severe airway infections with inspiratory stridor. After she recovered, a bronchoscopy and an esophagogram (Figure 1) were performed to screen for a vascular ring.

View larger version (110K): [in this window] [in a new window]   Figure 1. X-ray of the thorax: lateral view with barium enhancement of the esophagus. Dorsal narrowing in the upper third of the esophagus is produced by the right aortic arch.

An echocardiogram revealed a double aortic arch. For preoperative imaging, MR angiography was chosen, which clarified the pathological condition in detail. The investigation was performed on a 1.5 Tesla Magnetom (Vision, Siemens) using a phased array body coil. Paramagnetic gadolinium (Magnevist, Schering) with an injection rate of 3 mL/s was administered using an automated injector (Tomojet, Bruker). Then, a large 3D volume was acquired during breath-hold (23 s) using a standard angiographic sequence with the following parameters: repetition time/echo time/flip angle, 4.6 ms/1.8 ms/50°; rectangular field of view, 390x290 mm; slab thickness, 90 mm; acquisition time, 23 s; bandwidth, 390 Hz/pixel; and real voxel size, 1.36x0.76x3 mm³.

After image acquisition, volume-rendering was performed on a workstation (SGI) using a proprietary software tool (Virtuoso, Siemens). Figures 2 and 3 show details of the shaded-volume reconstruction of the double aortic arch. Additionally, a rotation of the 3D MRI is provided Online.

View larger version (145K): [in this window] [in a new window]   Figure 2. Ventral aspect of volume-rendered MR angiography. The frontal division of the aorta in a left (LAoA) and a right arch (RAoA) is displayed; both override the main, right, and left pulmonary arteries (LPA). An anonymous vein (V. Ann.) passes ventral to the left aortic arch. The right carotid (RC) and right subclavian artery (RSA) arise from the right aortic arch and the left carotid (LC) and the left subclavian artery (LSA) from the left aortic arch.

View larger version (125K): [in this window] [in a new window]   Figure 3. Dorsal aspect of volume-rendered MR angiography. The dorsal division of the left (LAoA) and right arch (RAoA) is displayed. The dorsal curvature of the right arch results from passing near the vertebral column. RPA indicates right pulmonary artery; LPA, left pulmonary artery; and V. Ann., anonymous vein.

The patient then underwent cardiac surgery. The vascular ring was opened, and the retroesophageal right-sided aortic arch was resected.

Footnotes

A 3D rotation of Figures 2 and 3 can be found Online at http://www.circulationaha.org

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Full Text (PDF) Movie Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Brockmeier, Articles by Floemer, Search for Related Content PubMed PubMed Citation Articles by Brockmeier, Articles by Floemer, Related Collections Cardiovascular imaging agents/Techniques CT and MRI