Copyright © 2005, The European Society of Cardiology
3-D echocardiographic imaging of double aortic arch
Department of Paediatric Cardiology, Wessex Cardiothoracic Unit, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
Received 18 July 2005; received in revised form 27 September 2005; accepted after revision 5 October 2005.
* Corresponding author. Tel.: +44 2380 777222; fax: +44 2380 794526.
muthu.kumaran{at}suht.swest.nhs.uk
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Delineation of arch abnormalities is difficult by conventional 2-D echocardiography and MRI has been the investigation of choice. 3-D echocardiography is increasingly used in congenital heart disease for both functional anatomy and morphology. This case report demonstrates that 3-D echocardiography can be used in delineating arch anomalies, which can avoid further imaging that needs a general anaesthetic.
Keywords: 3-D echocardiography; Double aortic arch
A 2-week-old baby, born at full-term by normal delivery, developed inspiratory stridor and poor feeding with slight increase in the work of breathing. Investigations included bronchoscopy and single plane CT scan of the chest. Bronchoscopy showed a pulsatile narrowed area in the right side of the trachea 2cm above the carina with distortion of the tracheal cartilage. CT scan suggested a vascular ring but was inconclusive due to poor image quality. Two-dimensional echocardiography was suggestive of a double arch but was deemed inadequate to proceed to surgery. MRI examination was planned but a 3-D echocardiography (3-D) was done prior to this [Phillips Sonos 7500]. This clearly defined double arch (Fig. 1) with right common carotid and subclavian arising from the right-sided arch (Fig. 2). The left arch was slightly smaller and gave rise to the left common carotid and subclavian. It was difficult to define its connection with the descending aorta (Fig. 3). The images obtained from the 3-D were convincing to avoid further studies. The findings were confirmed during surgical exploration. After identifying the right arch joining the descending thoracic aorta, the distal end of the left arch beyond the origin of the left subclavian artery was ligated and divided. She made a good recovery and was discharged home in five days.
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Delineation of arch abnormalities is difficult by conventional 2-D echocardiography and MRI has been the investigation of choice.1 3-D echocardiography is increasingly used in congenital heart disease for both functional anatomy and morphology. By this case report we have demonstrated that 3-D echocardiography can be used in delineating arch anomalies, which can avoid further imaging that needs a general anaesthetic.
Delineation of arch abnormalities is feasible by real time 3-D and is a valuable tool in the experienced hands for evaluating double aortic arch.
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- Lotz J., Macchiarini P. Images in clinical medicine. Double aortic arch diagnosed by magnetic resonance imaging. N Engl J Med (2004 Nov 25) 351(22):e20.[CrossRef]
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