Cor Vasa 2022, 64(3):320-323 | DOI: 10.33678/cor.2021.061

A rare association of avian aortic arch with a mid-arch narrowing of the aorta

Hend Keskes^a, Emna Bennour^a, Ahmed Sghaier^a, Ikram Kammoun^a, Meriem Affes^b, Sonia Marrakchi^a, Salem Kachboura

^a Cardiology Department, Abderrahman Mami's hospital - Ariana, Tunisia

^b Radiology Department, Abderrahman Mami's hospital - Ariana, Tunisia

Background: Variations of the aortic arch and its branches appear in a large number of possible combina- tions. Mid-aortic arch narrowing is rare, and represents 2.5-3.5% of all aortic coarctations. Avian arch is a two-branch arch with common origin of bilateral common carotids and common origin of bilateral subclavian arteries. It seems to be exceptional in humans. Although these two anomalies are well identified in isolation, their association seems very rare. Case presentation: We report a case of a 50-year-old patient presenting to our department complaining of dizziness and on-exertion fatigue of the upper limbs. Medical history revealed no hypertension and no diabetes mellitus and clinical examination showed a low blood pressure, no heart murmur, marked pulsa- tion of the carotids with a bilateral carotid murmur and a left latero-cervical mass. Radial pulses were weak and femoral pulses were absent. Electrocardiogram showed left atrial and ventricular hypertrophy. Chest X-ray was normal. 2-dimensional echocardiography showed moderately left atrial dilatation, ventricular hypertrophy with septal hypokinesia. Doppler ultrasound of supra-aortic trunks showed bilateral subclavian steal phenomenon and computed tomography angiography of the aorta, supra-aortic trunks, and brain vessels showed a two-branch aortic arch with a severe in-between narrowing, external carotid arteries were enlarged and a retropharyngeal aneurysm was present in the right carotid artery. Surgical treatment of the coarctation was successfully done. Postoperative recovery was good. At clinical examination, there was no hypertension, femoral and upper limbs pulses were present and symmetric. A radiological control 5 years later showed a permeable Dacron tube and a regression of the aneurysm.

Conclusion: Aortic arch anomalies have called the attention of several authors especially with advancements of endovascular interventions and complex surgical procedures. Their knowledge is of crucial importance before any interventional and surgical procedures in thorax and neck

Keywords: Avian arch, Aortic arch anomaly, Case report, Coarctation

Received: April 24, 2021; Revised: May 17, 2021; Accepted: May 19, 2021; Published: June 22, 2022  Show citation