Gluncić V, Lukić I K, Kopljar M, Sabljar-Matovinović M, Hebrang A, Marusić A
Department of Anatomy, Zagreb University School of Medicine, Croatia.
Surg Radiol Anat. 2002 Aug-Sep;24(3-4):226-30. doi: 10.1007/s00276-002-0030-9. Epub 2002 Jul 11.
A 15-year-old girl presented with upper extremity hypertension and continuous precordial murmur. Arteriography revealed aortic coarctation proximal to the origin of the left subclavian artery. An anomalous artery originated from the aortic arch, between the left common carotid artery and the stenosis. It ascended cranially and filled an angiomatous vascular formation on the left side of the neck. The "angioma" drained into the left subclavian artery. The embryological explanation of the described anomaly is difficult, but probably related to hemodynamic alterations following the prestenotic increase in blood pressure. This may have impaired the obliteration of cervical intersegmental arteries, resulting in the persistence of one of the first three intersegmental arteries as the anomalous branch of the aortic arch. The angiomatous vascular formation in the neck could be the consequence of altered development of anastomoses between the muscular twigs of both vertebral and deep cervical artery. The vessel draining the vascular formation was probably the thyrocervical trunk. Since there were no overt collateral channels or signs of left ventricular hypertrophy by electrocardiography and echocardiography, it seems that the aberrant collateral flow was hemodynamically significant and reduced the afterload on the myocardium. Although the pattern of collateral flow in our case might be considered extremely rare, it is important in preoperative planning and interpretation of imaging studies.
一名15岁女孩出现上肢高血压和心前区连续性杂音。动脉造影显示在左锁骨下动脉起源近端存在主动脉缩窄。一条异常动脉起源于主动脉弓，位于左颈总动脉和狭窄部位之间。它向头侧走行并供应颈部左侧的一个血管瘤样血管结构。该“血管瘤”引流至左锁骨下动脉。对所描述异常情况的胚胎学解释较为困难，但可能与狭窄前血压升高后的血流动力学改变有关。这可能阻碍了颈节段间动脉的闭塞，导致前三对节段间动脉之一持续存在，成为主动脉弓的异常分支。颈部的血管瘤样血管结构可能是椎动脉和颈深动脉肌支之间吻合支发育改变的结果。引流该血管结构的血管可能是甲状颈干。由于没有明显的侧支通道，且心电图和超声心动图未显示左心室肥厚迹象，似乎异常的侧支血流在血流动力学上具有重要意义，并减轻了心肌的后负荷。尽管我们病例中的侧支血流模式可能被认为极为罕见，但它在术前规划和影像学研究解读中很重要。
