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Condition

Double Aortic Arch

Condition 101

What is the definition of Double Aortic Arch?

Double aortic arch is an abnormal formation of the aorta, the large artery that carries blood from the heart to the rest of the body. It is a congenital problem, which means that it is present at birth.

What are the alternative names for Double Aortic Arch?

Aortic arch anomaly; Double arch; Congenital heart defect - double aortic arch; Birth defect heart - double aortic arch

What are the causes for Double Aortic Arch?

Double aortic arch is a common form of a group of defects that affect the development of the aorta in the womb. These defects cause an abnormal formation called a vascular ring (a circle of blood vessels).

Normally, the aorta develops from one of several curved pieces of tissue (arches). As babies develop in the womb, the arches split into several parts. The body breaks down some of the arches, while others form into arteries. A normally developed aorta is a single arch that leaves the heart and moves leftward.

In double aortic arch, some of the arches that should have disappeared are still present at birth in addition to the normal arch. Babies with a double aortic arch have an aorta that is made up of two vessels instead of one. The two parts to the aorta have smaller arteries branching off of them. As a result, the two branches go around and press down on the windpipe and the tube (esophagus) that carries food from the mouth to the stomach.

A double aortic arch may occur in other congenital heart defects, including:

  • Tetralogy of Fallot
  • Truncus arteriosus
  • Transposition of the great arteries
  • Ventricular septal defect

Double aortic arch is very rare. Vascular rings make up a small percentage of all congenital heart problems. Of these, a little more than half are caused by double aortic arch. The condition occurs equally in males and females. It is often present in people with certain chromosome abnormalities.

What are the symptoms for Double Aortic Arch?

Because symptoms of double aortic arch are often mild, the problem may not be discovered until the child is a few years old.

The double aortic arch may press on the trachea and esophagus, leading to trouble breathing and swallowing. The severity of the symptoms depends on how much the aortic arch is pressing on these structures.

Breathing symptoms include:

  • High-pitched sound during breathing (stridor)
  • Noisy breathing
  • Repeated pneumonias
  • Wheezing

Digestive symptoms may include:

  • Choking
  • Difficulty eating and swallowing
  • Vomiting

What are the current treatments for Double Aortic Arch?

Surgery can be done to fix double aortic arch. The surgeon ties off the smaller branch and separates it from the larger branch. Then the surgeon closes the ends of the aorta with stitches. This relieves pressure on the esophagus and windpipe.

What is the outlook (prognosis) for Double Aortic Arch?

Most children feel better right after surgery, although some may continue to have breathing symptoms for some time after surgical repair. This is most often due to weakness of the trachea because of the pressure on it before surgical repair.

In rare cases, if the arch is pressing down very hard on the airway, the child can have severe breathing difficulty that leads to death.

What are the possible complications for Double Aortic Arch?

Complications may include:

  • Failure to thrive
  • Respiratory infections
  • Wearing away of the lining of the esophagus (esophageal erosion) and windpipe
  • Very rarely, an abnormal connection between the esophagus and aorta (aortoesophageal fistula)

When should I contact a medical professional for Double Aortic Arch?

Call your provider if your infant has symptoms of double aortic arch.

How do I prevent Double Aortic Arch?

There is no known way to prevent this condition.

REFERENCES

Bryant R, Yoo S-J. Vascular rings, pulmonary arterial sling, and related conditions. In: Wernovsky G, Anderson RH, Kumar K, Mussatto K, et al, eds. Anderson's Pediatric Cardiology. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 47.

Fraser CD, Kane LC. Congenital heart disease. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 58.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Other congenital heart and vascular malformations. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 459.

Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease in the adult and pediatric patient. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 75.

Data Source : ADAM

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Double aortic archVascular ring