Double symmetrical aortic arch in a Czechoslovakian wolfdog - surgical treatment and health assessment four years after treatment: a case report

Abstract

ABSTRACT:The paper describes a double symmetrical aortic arch in a dog trapping the oesophagus. Thoracotomy was performed in the fourth inter-costal space under general, isoflurane-maintained, anaesthesia. Cutting of the arterial ligament failed to free the oesophagus. Dissection of further vascular structures revealed the left and right aortic arches to be of similar diameter. A vascular clamp was put on the left arch for 10 min, while the patient's cardiovascular parameters were monitored. The lack of significant cardio-respiratory symptoms indicated the necessity of ligating and cutting the left aortic arch. Removal of additional tissue from the region of the cut on the left arch completely released the oesophagus which was continuously monitored by video-oesophagoscopy. The chest was closed according to a standard thoraco-surgical procedure. The cutting of the left aortic arch and the release of the surrounding tissue restored the normal position of the oesophagus. After surgery, the animal was returned to its owners in a very good condition. Control examination showed complete amelioration of clinical symptoms and subsequent normal development of the dog. Intra-operative clamping of the left aortic arch with simultaneous monitoring by oesophagoscopy ensured a positive outcome of the surgery of the intra-operatively diagnosed double aortic arch.

Successful Surgical Therapy of a Double Aortic Arch in a 10-Month-Old Mixed Breed Dog

“…To our knowledge, this is the only case of double aortic arch in the literature that had an advanced imaging diagnosis prior to surgery. In previous cases of surgical correction of double aortic arch, a good outcome was achieved despite the lack of surgical planning [19, 21, 22]. However, the addition of CT imaging may have contributed to the excellent outcome in this case, as it allowed planning for a right-sided thoracotomy which led to less unnecessary dissection that may have been sustained if a standard left thoracotomy approach had been made.…”

“…The right aortic arch is most commonly the dominant arch, followed by left dominant, and symmetrical aortic arches are the least common [8]. All 3 categories have been reported in the veterinary literature [4, 6, 19–22]. In this case, unlike the majority of humans, the dominant aorta was on the left, making the right aortic arch the better candidate for ligation.…”

“…This is the result of a complete vascular ring encircling the esophagus leading to cranial esophageal dilation [6]. With double aortic arch, dyspnea, wheezing, and other respiratory signs may also be seen [4, 20–22, 26]. Indeed, human patients with vascular ring anomalies have a higher incidence of respiratory signs (70-95%) than gastrointestinal signs (5-50%) [27, 28].…”

“…However, this puts the surgeon at a disadvantage in the 5% of the time that an uncommon vascular ring anomaly is present. Indeed, in the previously reported literature [4, 6, 14–22], the diagnosis of double aortic arch was only made intraoperatively or at necropsy. The atypical presentation of an older patient with respiratory signs led the authors to more strongly recommend CT prior to exploratory thoracotomy.…”

“…CT or MRI is currently the preferred imaging modalities for preoperative planning [10–13]. Double aortic arch in dogs is considered rare with very few reports published in the literature [4, 6, 14–22]. It has also been reported in a Siamese cat [23], a talapoin monkey [24], and a white lion [25].…”