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
- 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
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References
- Katsumata T, Westaby S. Operation of mid-arch coarctation. Ann Thorac Surg 1999;67:1386-1390.
Go to original source...
Go to PubMed...
- Winer HE, Kronzon I, Glassman E, Cunningham JN Jr, Madayag M. Pseudocoarctation and mid-arch aortic coarctation. Chest 1977;72:519-521.
Go to original source...
Go to PubMed...
- Ellis FH Jr, Clagett OT. Coarctation of the Aorta Proximal to the Left Subclavian Artery: Experience with Six Surgical Cases. Ann Surg 1957;146:145-151.
Go to original source...
Go to PubMed...
- Ergun O, Tatar IG, Durmaz HA, et al. A case of a rare aortic arch variation: the avian form. JBR-BTR 2014;97:349-350.
Go to original source...
Go to PubMed...
- Rueda-Medina I, García-Ruíz R, Del Saz-Saucedo P, Turpín-Fenoll L. Common origin of carotid and subclavian arteries as an exceptional anatomical variant of the aortic arch. Neurología 2011;26:244-255.
Go to original source...
Go to PubMed...
- Jakanani GC, Adair W. Frequency of variations in aortic arch anatomy depicted on multidetector CT. Clin Radiol 2010;65:481-487.
Go to original source...
Go to PubMed...
- Natsis KI, Tsitouridis IA, Didagelos MV, et al. Anatomical variations in the branches of the human aortic arch in 633angiographies: clinical significance and literature review. Surg Radiol Anat 2009;31:319-323.
Go to original source...
Go to PubMed...
- Boyaci N, Dokumaci DS, Karakas E. Multidetecor computed tomography evaluation of aortic arch and branching variants. Turk Gogus Kalp Dama 2015;23:51-57.
Go to original source...
- Stojanovska J, Cascade PN, Chong S, et al. Embryology and imaging review of aortic arch anomalies. J Thorac Imaging 2012;27:73-84.
Go to original source...
Go to PubMed...
- Karacan A, Türkvatan A, Karacan K. Anatomical variations of aortic arch branching: evaluation with computed tomographic angiography. Cardiol Young 2013;22:1-9.
Go to original source...
Go to PubMed...
- DeRoo S, Dillman JR, Cascade P, et al. Aortic Arch Anomalies. In: Saremi F (ed.) Cardiac CT and MR for Adult Congenital Heart Disease. Springer: New York, NY, 2014.
Go to original source...
- Tsikrikas S, Charalampous C, Letsas KP. A case of severe asymptomatic aortic coarctation in an adult female. Case Rep Cardiol 2011;2011:535463.
Go to original source...
Go to PubMed...
- Reinshagen L, Vodiskar J, Mühler E, et al. Bicarotid Trunk: How Much Is "Not Uncommon"? Ann Thorac Surg 2014;97:945-949.
Go to original source...
Go to PubMed...
- Türkvatan A, Büyükbayraktar FG, Ölçer T, Cumhur T. Congenital Anomalies of the Aortic Arch: Evaluation with the Use of Multidetector Computed Tomography. Korean J Radiol 2009;10:176-184.
Go to original source...
Go to PubMed...
- Lemke AJ, Benndorf G, Liebig T, Feli R. Anomalous origin of the right vertebral artery: review of the literature and case report of right vertebral artery origin distal to the left subclavian artery. AJNR Am J Neuroradiol 1999;20:1318-1321.
- Amini R, Gornik HL, Gilbert L, et al. Bilateral Subclavian Steal Syndrome. Case Rep Cardiol 2011;2011:146267.
Go to original source...
Go to PubMed...
- Lord RS, Adar R, Stein RL. Contribution of the circle of Willis to the subclavian steal syndrome. Circulation1969;40:871-878.
Go to original source...
Go to PubMed...
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