Rings, Slings, and Other Things: Vascular Structures Contributing to a Neonatal “Noose”

Moës, C. A. F.; Freedom, Robert M.

doi:10.1007/978-1-4471-1814-5_43

Cited by 6 publications

(3 citation statements)

References 74 publications

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“…Aortic arch anomalies have been classified into three main categories (Moes and Freedom, 1992): Group I (anomalies associated with double aortic arch), Group II (anomalies associated with left aortic arch), and Group III (anomalies associated with right aortic arch). However, increasing recognition of previously unappreciated anomalies by newer diagnostic techniques has prompted an elaboration of this classification.…”

Section: Discussionmentioning

confidence: 99%

Right aortic arch with isolated left brachiocephalic artery

Singh¹,

Satyapal²,

Moodley³

et al. 2000

Clin. Anat.

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Section: Discussionmentioning

confidence: 99%

Right aortic arch with isolated left brachiocephalic artery

Singh¹,

Satyapal²,

Moodley³

et al. 2000

Clin. Anat.

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“…The prevalence of DAA is reported in literature as low as 0.005%-0.007% 1,2 up to 0.01% 3 while the prevalence of RAA is estimated at 0.1% 1,2 . In the DAA cases the aortic arches can be similar in size but most frequently, the right is dominant, occurring in about 75% of the cases 4,5 . In most cases there is a left sided arterial duct.…”

Section: Introductionmentioning

confidence: 99%

Double aortic arch: implications of antenatal diagnosis, differential growth of arches during pregnancy, associated abnormalities and postnatal outcome

Bartsota

Jowett

Manuel

et al. 2023

Ultrasound in Obstet & Gyne

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This is the largest antenatal series of double aortic arch (DAA). It shows that in the vast majority of cases both arches are patent prenatally, but postnatally the left arch is atretic in most patients, supporting the theory of differential growth of the arches. Postnatal cases of DAA with atretic left can be misinterpreted as right aortic arch and thorough assessment by computed tomography (CT) is required. What are the clinical implications of this work?This work will help and guide antenatal counseling and postnatal management of cases of DAA. Based on our findings, the recommendation is for these patients to be delivered at hospitals where neonatal support is available, to have early postnatal pediatric cardiology review and to undergo CT irrespective of the presence of symptoms or not.

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“…The lesion was diverticular rather than aneurysmal and measured 3 cm in diameter, but extended posteriorly for 6.5 cm between the aorta and the esophagus (not described). Because a true Kommerell's diverticulum in the presence of a right-sided arch represents a remnant of the left dorsal aorta, it can be speculated that, embryologically, the anomaly comprised a right arch with a retroesophageal left ductus arteriosus, 3,4 and that progressive closure of the ductus after birth determined an atretic segment-ie, the ligamentum arteriosum proper and the posterior left portion of the vascular ring-along with a Kommerell's diverticulum originating from the aortic isthmus (Fig); differentiation from double aortic arch with left arch atresia distal to the left subclavian artery is virtually impossible although in the latter condition the left innominate artery is tethered caudally and more horizontal. This specific anatomy closely resembles that described by Cinà in Case 1 prior to reoperation, in a patient who underwent previous division of the ligamentum arteriosum and of an aberrant left subclavian artery through the left chest.In our case the diverticulum's root was divided on a sidebiting clamp, with no clamp-and-go, avoiding extensive mobilization posterior to the esophagus because of the adhesive and fragile nature of the surrounding tissues.…”

mentioning

confidence: 99%

Regarding “Kommerell's diverticulum and right-sided aortic arch: a cohort study and review of the literature”

Pocar

Moneta

Villa

et al. 2004

Journal of Vascular Surgery

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and previous 1 reviews by Cinà et al describing the approach to patients with a Kommerell's diverticulum and a right-sided aortic arch. A similar case previously published in the Journal by our group 2 is cited in the recent article, although some features are not reported while others are outlined incorrectly.Our patient presented with severe dysphagia and milder compression symptoms due to an isolated Kommerell's diverticulumie, very unusually, with no vascular ring-and a right-sided aortic arch. The origin of the supra-aortic vessels corresponded to Edward's type I (mirror image). The lesion was diverticular rather than aneurysmal and measured 3 cm in diameter, but extended posteriorly for 6.5 cm between the aorta and the esophagus (not described). Because a true Kommerell's diverticulum in the presence of a right-sided arch represents a remnant of the left dorsal aorta, it can be speculated that, embryologically, the anomaly comprised a right arch with a retroesophageal left ductus arteriosus, 3,4 and that progressive closure of the ductus after birth determined an atretic segment-ie, the ligamentum arteriosum proper and the posterior left portion of the vascular ring-along with a Kommerell's diverticulum originating from the aortic isthmus (Fig); differentiation from double aortic arch with left arch atresia distal to the left subclavian artery is virtually impossible although in the latter condition the left innominate artery is tethered caudally and more horizontal. This specific anatomy closely resembles that described by Cinà in Case 1 prior to reoperation, in a patient who underwent previous division of the ligamentum arteriosum and of an aberrant left subclavian artery through the left chest.In our case the diverticulum's root was divided on a sidebiting clamp, with no clamp-and-go, avoiding extensive mobilization posterior to the esophagus because of the adhesive and fragile nature of the surrounding tissues. Although this technique has not been previously described, it is worth mentioning that tangential clamping and direct suture was straightforward, probably because, in the absence of an aberrant subclavian artery, the surrounding aorta was relatively normal and non-aneurysmal.We agree that distal perfusion is preferable to a clamp-and-go technique if aortic cross clamping is necessary. The idea of performing left heart bypass with left atrial drainage through the right chest is appealing, and the technique can safely be converted to full cardiopulmonary bypass if required.Except for potential applications of endovascular stent grafting, 5 we concur that a right posterolateral thoracotomy through the 4th intercostal space, with or without rib resection, is the best approach to a right-sided upper descending aorta. We also strongly agree that an aberrant subclavian artery should be transposed and reimplanted or bypassed rather than divided, and that a combined cervical-thoracic strategy is preferable to an extended entirely thoracic approach; in this respect, we would like to stress that we did not ...

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Rings, Slings, and Other Things: Vascular Structures Contributing to a Neonatal “Noose”

Cited by 6 publications

References 74 publications

Right aortic arch with isolated left brachiocephalic artery

Right aortic arch with isolated left brachiocephalic artery

Double aortic arch: implications of antenatal diagnosis, differential growth of arches during pregnancy, associated abnormalities and postnatal outcome

Regarding “Kommerell's diverticulum and right-sided aortic arch: a cohort study and review of the literature”

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