Right-sided aortic arch with isolation of the left innominate artery and hypoplasia of the left internal carotid artery.

PURPOSE: Here, we report a case of the right-sided aortic arch with isolation of the left innominate artery and hypoplasia of the left internal carotid artery. METHODS: A 42-year-old male patient underwent a whole-body computed tomography angiography (CTA) examination upon the clinical suspicion of vasculitis. RESULTS: CTA revealed a right-sided aortic arch with the isolation of the left innominate artery and hypoplasia of the left internal carotid artery. CONCLUSION: The right-sided aortic arch, with the isolation of the left innominate artery, is a scarce vascular variation that may occur with other cardiovascular anomalies such as ventricular septal defect. It can be asymptomatic or can present with symptoms of subclavian steal syndrome. Although its association with the agenesis of the left internal carotid artery has been reported, its association with the hypoplasia of the left internal carotid artery has not been reported previously to the best of our knowledge.

Morphological, embryological, and clinical implications of the bi-carotid trunk, aberrant right subclavian artery, and bilateral linguofacial trunk.

A female cadaver fixated with 10% formalin solution was dissected during a routine undergraduate anatomy class. It was found that both the right and left carotid arteries arose from a bi-carotid trunk as the first branch of the aortic arch. The bi-carotid trunk was followed by the left subclavian artery. The aberrant right subclavian artery (the last branch) had a retro-oesophageal course. These variations were associated with the linguofacial trunk bilaterally. The group of variant anatomy of vessels encompassing the bi-carotid trunk, aberrant right subclavian artery, and the linguofacial trunk is extremely rare. A similar case has not been reported yet in the literature. The anatomic and morphologic variations of the aortic arch and its branches are important for diagnostic and surgical procedures in the thorax and neck region. Thoracovascular surgeons and interventional radiologists should be aware of these anomalies during head and neck surgery, aortic instrumentation, and four-vessel angiography.

Right vertebral artery arising from the right common carotid artery with an absent brachiocephalic trunk.

The right and left vertebral arteries are the first branches of the ipsilateral subclavian arteries. However, in the presence of anatomical variation due to complex embryogenesis, the vertebral artery can arise directly from the aortic arch or any of its major branches. The atypical origin of the vertebral artery is commonly associated with the left vertebral artery. Anatomical variation in the origin of the right vertebral artery is rare. Most available reports are case reports from international studies. We report on a case of right vertebral artery arising from the ipsilateral common carotid artery with an absent brachiocephalic trunk in a South African patient examined by digital subtraction angiography. Reports on anatomical variations are of diagnostic importance prior to surgical interventions or endovascular treatment of cerebrovascular diseases such as cerebral aneurysms and arteriovenous malformations.

Is Transposition of the Great Arteries Associated With Shortening of the Intrapericardial Portions of the Great Arterial Trunks? An Echocardiographic Analysis on Newborn Infants With Simple Transposition of the Great Arteries to Explore an Animal Model-Based Hypothesis on Human Beings.

Background The pathogenesis of transposition of the great arteries (TGA) as a congenital heart defect of the outflow tract with discordant ventriculoarterial connections remains an enigma. TGA usually have parallel great arteries suggesting that deficient torsion of the embryonic arterial heart pole might cause discordant ventriculoarterial connections. It has been speculated that deficient elongation of the embryonic outflow tract might prevent its normal torsion resulting in TGA. The aim of our study was to clarify whether the intrapericardial portions of the great arteries in human patients with TGA might be indeed shorter than in normal hearts. Methods and Results Thirty-four newborns with simple TGA and 35 newborns with normal hearts were analyzed by using images of the outflow tract in their echocardiograms and the following defined lengths of the great arteries were measured: aortic length 1, (AoL-1) and aortic length 2 (AoL-2) = distance between left and right aortic valve level and origin of the brachiocephalic artery, respectively. Pulmonary trunk length 1 (PTL-1) and pulmonary trunk length 2 (PTL 2) = distance between left and right pulmonary valve level and origin of left and right pulmonary artery, respectively. All measurements of the AoL were significantly shorter in TGA compared to normal hearts (AoL-1: 1.6±0.2 versus 2.05±0.1; P<0.0001; AoL-2: 1.55±0.2 versus 2.13±0.1; P<0.0001). With regard to the pulmonary trunk (PT), PTL-1 and PTL-2 were found to be shorter and longer, respectively, in TGA compared with normal hearts, reflecting the differences in the spatial arrangement of the PT between the 2 groups as in TGA the PT is showing a mirror image of the normal anatomy. However, the overall length of the PT between the 2 groups did not differ. Conclusions Our data demonstrate that, compared with normal newborns, the ascending aorta is significantly shorter in newborns with TGA whereas the overall length of the PT does not differ between the 2 groups. This finding is in accord with the animal model-based hypothesis that TGA may result from a growth deficit at the arterial pole of the embryonic heart.

Anomalous innominate artery complicating tracheal surgical procedures.

OBJECTIVE: To highlight the importance of imaging in reducing an accidental injury to the anomalous brachiocephalic trunk and its branches during tracheal surgery. CASE REPORT: This paper reports two cases of accidental injury to the great vessels in the neck during tracheal surgery. The first incident occurred during a repeat tracheostomy, when the right common carotid artery was injured. On reviewing the computed tomography images, the bifurcation of the brachiocephalic artery was seen to the left of the midline, and the right common carotid artery was adherent just below the tracheostomy site. The second incident happened during surgery for tracheal stenosis, when there was an inadvertent injury to the main brachiocephalic trunk, which was adherent to the trachea in the lower neck region. CONCLUSION: For airway surgeons, radiological assessment of vascular structures in relation to the trachea prior to surgery is as important as the endoluminal airway assessment for the best outcome.

Isolated subclavian or brachiocephalic arteries with tetralogy of Fallot, left retro-aortic brachiocephalic vein.

BACKGROUND: Isolated subclavian or brachiocephalic artery are uncommon aortic arch anomalies. Here we report the anatomy and histology of this disease. METHODS: Four cases of congenital isolated subclavian or brachiocephalic artery in fetuses are described. RESULTS: We identified one case of right aortic arch with isolated left subclavian artery associated with the tetralogy of Fallot, two cases of right aortic arch with isolated left brachiocephalic artery (one case with left retro-aortic brachiocephalic vein), and one case of left aortic arch with isolated right subclavian artery associated with coarctation of the aorta and cervical aortic arch. The proximal subclavian or brachiocephalic artery is arterial duct. CONCLUSION: Aortic arches with an isolated subclavian or brachiocephalic artery are often associated with the tetralogy of Fallot. It also can be associated with rare abnormalities such as left retro-aortic brachiocephalic vein or cervical aortic arch. Isolated LBA can be associated with microdeletion chromosome 22q11.

Absent left common carotid artery in a right aortic arch: Separate origins of left internal and external carotid arteries from brachiocephalic artery.

We present a case of cyanotic congenital heart disease with left common carotid artery agenesis in the setting of the right aortic arch highlighting the potential implications in management.

A two-vessel aortic arch: Rare configuration with bilateral brachiocephalic arteries.

We present a case of type B aortic dissection with a rare aortic arch branching variation whereby two separate brachiocephalic trunks arise from the arch. This case also highlights the potential implications of this variant in the management of thoracic aortic dissections and aneurysms.

Coronary Angiography in Patients with Arteria Lusoria via Right Radial Access: A Case Series and Literature Review.

Transradial is becoming the access of choice for coronary angiography (CAG). Arteria lusoria (AL) poses a challenge for right transradial access because it can cause difficulty in accessing the ascending aorta. Of 18,686 patients who underwent CAG in Geisinger Medical Center from 2012 to 2018, 6 had a diagnosis of AL. Four underwent attempted right radial access, in 3 cases before AL was identified. All were successful, and one patient had successful right transradial percutaneous coronary intervention. CAG and PCI can be successfully performed using right radial access in patients with AL.

Successfully Kissing Stent of Innominate Artery and Left Common Carotid Artery Subsequent to Blunt Injury, in the Setting of a Bovine Aortic Arch.

Blunt injuries of the great vessels arising from the aortic arch are usually fatal. The innominate artery lesions represent the most common site of injury after the aortic isthmus distal to the left subclavian artery. Injuries are usually located at the origin of the vessel from the aortic arch, especially in patients with bovine aortic arch. Open traditional repair is a successful but invasive treatment, with long hospital stay and different possible complications. Although a bovine aortic arch presents an increased technical challenge, it is possible to achieve a complete and safe repair of the innominate artery injuries through a total endovascular treatment, with important reduction of risks and complications related to operation, compared to traditional open repair. We report the case of a 62-year-old man in our hospital with a posttraumatic pseudoaneurysm of the innominate artery in the setting of a bovine aortic arch, associated with a transection of the descending thoracic aorta. In the urgent setting, the patient was submitted to a kissing stent of innominate artery-left common carotid artery and deployment of thoracic endoprosthesis to exclude the aortic transection, with good final result.

The so-called "bovine aortic arch": a possible biomarker for embolic strokes?

PURPOSE: To examine the prevalence of the so-called bovine aortic arch variation (common origin of the brachiocephalic trunk and the left common carotid artery) in embolic stroke patients, compared with a control group. METHODS: Aortic arch branching patterns were retrospectively evaluated in 474 individuals with (n = 152) and without (n = 322) acute embolic stroke of the anterior circulation. Contrast-enhanced CT scans of the chest and neck (arterial contrast phase, 1-2-mm slice thickness) were used to evaluate aortic arch anatomy. The stroke cohort included 152 patients who were treated for embolic strokes of the anterior circulation between 2008 and 2018. A total of 322 randomly selected patients who had received thoracic CT angiographies within the same time frame were included as a control group. RESULTS: With a prevalence of 25.7%, the bovine aortic arch variant was significantly more common among patients suffering from embolic strokes, compared with 17.1% of control patients (p = 0.039, OR = 1.67, 95%CI = 1.05-1.97). Stroke patients were more likely to show the bovine arch subtype B (left common carotid artery originating from the brachiocephalic trunk instead of the aortic arch) (10.5% vs. 5.0%, p = 0.039, OR = 2.25, 95%CI = 1.09-4.63), while subtype A (V-shaped common aortic origin of the brachiocephalic trunk and the left carotid) was similarly common in both groups. There was no significant difference regarding the frequency of other commonly observed variant branching patterns of the aortic arch. CONCLUSION: The bovine aortic arch, particularly the bovine arch subtype B, was significantly more common among embolic stroke patients. This might be due to altered hemodynamic properties within the bovine arch.

A case of right aortic arch with isolated left innominate artery and global cerebral white matter atrophy.

A right aortic arch with an isolated left innominate artery is a rare form of aortic arch anomaly. We present a case of neonatal diagnosis of this anomaly with concerning findings of global cerebral white matter atrophy at 13 months of age.

Anomaly in the Embryogenesis of the Aorta associated with Subclavian Steal Phenomenon.

Congenital aortic arch anomalies are rare and may be associated with other congenital cardiovascular malformations. The authors report a rare case of anomaly in the aortic arch embryogenesis, presenting with a right aortic arch and an isolated innominate artery, associated with the subclavian steal phenomenon. This condition is discussed considering the Edwards hypothetical double embryonic arch and its clinical aspects.

Incomplete isolation of the left innominate artery from the right aortic arch: a rare case of double-outlet right ventricle with pulmonary stenosis.

Isolation of the left innominate artery from the right aortic arch is a rare anomaly. Herein, we present an even rarer case of incomplete isolation of the proximal left innominate artery with the right aortic arch in a 3-month-old female infant with a double-outlet right ventricle and pulmonary stenosis. Surgical repair at 6 months of age was successful, leading to the restoration of adequate flow in the left arm.

Prevalence and Types of Aortic Arch Variants and Anomalies in Congenital Heart Diseases.

RATIONALE AND OBJECTIVES: Aortic arch (AA) variants and anomalies are important to recognize in patients with congenital heart disease (CHD) before surgery or intervention. The aim was to study the prevalence of AA anomalies and variants in patients with CHD compared to a control group. The secondary outcome was to report the associations between common variations of AA and specific types of CHD. MATERIALS AND METHODS: After institutional review board approval, computed tomography studies of 352 CHD patients and control group of 400 consecutive computed tomography scans of the thorax were evaluated. The AA was assigned to one of seven common types, and their distribution was compared between CHD and control. The distribution of the AA anomalies and variants was evaluated as regard specific types of CHD and the visceroatrial situs. RESULTS: Normal three-vessel branching pattern was the commonest in both groups, but was present in only 50.5% in the CHD compared to 68.5% in the control group, p < 0.00001. Right AA and aberrant right subclavian artery were significantly more common in CHD than control group (18.1% versus 0.25%, p < 0.00001) and (4.5% versus 0.25%, p = 0.0001), respectively. Direct aortic origin of left vertebral artery was insignificantly more common in CHD group (4.2% versus 2.7%, p = 0.258). Brachiobicephalic trunk was significantly more common in control than CHD group (27.7% versus 19.3%, p = 0.007). CONCLUSION: Normal three-vessel AA was significantly less common in CHD. AA anomalies (right arch and aberrant right subclavian) were more common in CHD than control, while AA variants (brachiobicephalic trunk and direct aortic origin of left vertebral artery) were not.

Factores que influyen en los resultados de fístula traqueoinnominada I / Influential factors in the results of traqueoinnonate fistula I

Introducción: La fístula traqueoinnominada, aunque poco frecuente, constituye una amenaza potencial para la vida, si no es reconocida y tratada oportunamente. Objetivo: Describir los resultados obtenidos e identificar las acciones que permitan identificarlos. Métodos: Se realizó el estudio retrospectivo, sobre una base de datos prospectiva de pacientes con fístulas traqueonominadas tratados entre 1991 y 2013. Los enfermos se clasificaron según la operación previa: traqueostomía, uso de tubo en T en reintervenciones con intensión de resecar el segmento traqueal estenótico. La revisión de la patogenia y de los métodos diagnósticos permitirán una mejor comprensión para enfrentar esta temible complicación. Se analizan los factores que pudieron influenciar los resultados. Resultados: Cuatro pacientes pertenecían al sexo femenino. Dos tenían una traqueostomía, dos fueron reoperados después de tratamiento con tubo en T; a uno se le realizó resección y anastomosis traqueal y en el otro no fue posible porque se produjo lesión puntiforme traqueal durante la disección mediastinal. Al último se le había colocado un tubo en T, mediante traqueofisura. En dos de tres pacientes, el sangrado centinela se interpretó incorrectamente. En el primero, se consideró que era la consecuencia del tratamiento anticoagulante y en el segundo no se dio valor a la pequeña cantidad de sangre en los esputos. Conclusiones: Un alto índice de sospecha, el diagnóstico temprano y las medidas al pie de la cama: compresión digital y colocación de un tubo ET o una cánula de traqueostomía con el manguito hiperinsuflado, constituyen la única esperanza para estos pacientes(AU)

Introduction: The tracheoinnominate fistula, though a rare entity, is a potential life threat if it is not promptly recognized and treated. Objective: To analyze the influential factors in the results of tracheoinnominate fistula I. Methods: Retrospective study supported on the prospective databases from patients with tracheoinnominate fistulae, who had been treated from 1991 to 2013. They were classified according to their previous surgery: tracheostomy, use of a T-tube or re-interventions aimed at resecting the stenotic tracheal segment. The review of pathogeny and of diagnostic methods allowed a better understanding to face this severe complication. The factors that could have an impact on the results were also analyzed. Results: Four patients were women. Two patients had undergone tracheostomy; two had been reoperated after treatment with T-tube; resection and tracheal anastomosis were performed in one of them but these procedures were not possible to be applied to the other because of a punctiform tracheal lesion during the mediastinal dissection. A T-tube had been placed in this last patient through tracheofissure. The sentinel bleeding in two of three patients was not properly evaluated. In one of them, the bleeding was considered to be the result of anticoagulant treatment whereas in the other, the small amount of blood in the sputum was underassessed. Conclusions: High amount of suspicion, early diagnosis and application of bedside measures such as digital compression, placement of a T-tube or a tracheostomy cannula with overinflated cuff are the only hopeful options for these patients(AU)