Isohata Hitoshi, Honda Takashi, Yamazaki Yu, Goto Hiroyuki, Yoshimura Yoshihiro, Hattori Kyoko, Shimaoka Takao, Sekiguchi Kazuki, Onishi Yoko, Kitagawa Atsushi, Hirata Yoichiro, Ochiai Daigo
Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Japan.
Radiol Case Rep. 2024 May 17;19(8):3254-3257. doi: 10.1016/j.radcr.2024.04.060. eCollection 2024 Aug.
Double aortic arch (DAA) is a rare congenital abnormality characterized by a vascular ring that often requires surgical intervention due to respiratory complications. The DAA and right aortic arch with mirror-image branches (RAA-MB) represent abnormalities in development of the aortic arch. However, prognosis differs significantly, as the DAA forms vascular rings, whereas the RAA-MB typically does not. Distinguishing between the conditions becomes particularly challenging in cases of DAA with closure of the posterior portion of the left aortic arch (LAA) because the postnatal manifestations closely resemble those of RAA-MB. Herein, we present a case of DAA in which longitudinal observation of the LAA and RAA diameters during pregnancy aimed in predicting postnatal closure of the LAA. A 37-year-old female with suspected DAA was referred to our hospital at 26 weeks of gestation. Initial measurements revealed comparable diameters for the LAA and RAA; however, the LAA diameter decreased to approximately half that of the RAA by term owing to growth restrictions. Postnatal contrast computed tomography confirmed the closure of the posterior portion of the LAA and RAA with Kommerell diverticulum. Our findings suggest that careful monitoring of DAA throughout fetal development, especially during the third trimester, may aid in predicting atretic changes in the nondominant arch after birth, allowing an easy distinction between the DAA and RAA-MB after birth.
双主动脉弓（DAA）是一种罕见的先天性异常，其特征是形成血管环，常因呼吸并发症而需要手术干预。DAA和镜像分支的右主动脉弓（RAA-MB）代表主动脉弓发育异常。然而，预后差异显著，因为DAA形成血管环，而RAA-MB通常不形成。在左主动脉弓（LAA）后部闭合的DAA病例中，区分这两种情况变得特别具有挑战性，因为出生后的表现与RAA-MB非常相似。在此，我们报告一例DAA病例，在孕期对LAA和RAA直径进行纵向观察，旨在预测出生后LAA的闭合情况。一名怀疑患有DAA的37岁女性在妊娠26周时被转诊至我院。初始测量显示LAA和RAA直径相当；然而，由于生长受限，足月时LAA直径降至RAA的约一半。出生后对比增强计算机断层扫描证实LAA后部和RAA伴有Kommerell憩室闭合。我们的研究结果表明，在整个胎儿发育过程中，尤其是在孕晚期，对DAA进行仔细监测，可能有助于预测出生后非优势弓的闭锁变化，从而在出生后轻松区分DAA和RAA-MB。
