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Image in Cardiology
Double aortic arch as cause of persistent stridor: Sequential imaging for preoperative assessment
Duplo arco aórtico na origem de estridor persistente: sequência de imagens para orientação cirúrgica
Bruno Sanchesa,
Corresponding author
brsan82@gmail.com

Corresponding author.
, Duarte Rebelob, Sara Britoc, Rui Anjosd, Luísa Loboe, Teresa Bandeiraf, Ana Saiandaf
a Serviço de Pediatria, Hospital Garcia de Orta, Almada, Portugal
b Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
c Serviço de Pediatria, Centro Hospitalar de Leiria, Leiria, Portugal
d Serviço de Cardiologia Pediátrica, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
e Serviço de Radiologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
f Unidade de Pneumologia Pediátrica, Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
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    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Duplo arco a&#243;rtico na origem de estridor persistente&#58; sequ&#234;ncia de imagens para orienta&#231;&#227;o cir&#250;rgica"
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    ]
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Thoracic computed tomography &#40;angio-CT&#41; angiography&#44; axial view&#44; showing two aortic arches &#40;arrows&#41; forming a double aortic arch&#44; which surround the airway and reduce tracheal caliber&#46; The right aortic arch is dominant&#46;</p>"
        ]
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    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A boy aged 2&#46;5 years presented biphasic stridor at three months of age&#44; which worsened with crying&#44; feeding and upper respiratory tract infections&#46; Fiberoptic bronchoscopy &#40;FOB&#41; at five months diagnosed tracheomalacia&#44; with 80&#37; dynamic collapse of the lower two-thirds of the trachea&#46; The child had normal growth and no difficulty feeding&#46; FOB at 21 months due to persistent stridor showed marked dynamic collapse and extrinsic compression of the trachea&#46; Thoracic computed tomography &#40;angio-CT&#41; angiography identified a vascular ring due to a double aortic arch &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figures 1&#8211;3</a>&#41;&#44; causing extrinsic compression of the trachea with marked reduction in its caliber &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41;&#46; There were no other cardiac malformations on echocardiographic study&#46; At 23 months the child underwent ligation and division of the more hypoplastic arch &#40;left anterior&#41; by thoracotomy&#46; The postoperative course was good&#44; and the child currently has mild stridor only&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Vascular rings account for 1&#37; of congenital heart defects and are the most common malformation causing airway compression&#46; In this case&#44; the clinical presentation dictated the sequence of imaging exams &#8211; FOB followed by angio-CT&#46; This combination of imaging techniques is essential for preoperative assessment&#46; angio-CT angiography provides better spatial and temporal resolution&#44; rapid image acquisition requiring only sedation or brief anesthesia in uncooperative patients&#44; and three-dimensional image reconstruction&#44; and is thus the preferred imaging modality&#44; especially with the lower radiation levels required with modern equipment&#46; Assessment of tracheomalacia or other airway dysfunction still requires video bronchoscopy&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Ethical disclosures"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Sanches B&#44; Rebelo D&#44; Brito S&#44; et al&#46; Duplo arco a&#243;rtico na origem de estridor persistente&#58; sequ&#234;ncia de imagens para orienta&#231;&#227;o cir&#250;rgica&#46; Rev Port Cardiol&#46; 2015&#59;34&#58;629&#8211;630&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thoracic angio-CT angiography&#44; coronal maximum intensity projection reconstruction&#44; showing two aortic arches &#40;arrows&#41; originating in the ascending aorta&#46; The brachiocephalic trunk originates in the right aortic arch&#44; while the left common carotid originates in the left aortic arch&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Thoracic angio-CT angiography&#44; three-dimensional reconstruction&#44; posterior view&#44; showing two aortic arches &#40;arrows&#41; that join in the proximal descending aorta&#46; The right aortic arch is of larger caliber&#46;</p>"
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Article information
ISSN: 21742049
Original language: English
DOI:10.1016/j.repce.2015.08.014
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