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Aortic Arch Variants and Anomalies: Embryology, Imaging Findings, and Clinical Considerations

Sang Hyeon Kim|권희진|Jong-Min Lee|Eun-Ju Kang|Ki Seok Choo|Sang Bin Bae|Kyoung Jae Lim
한국심초음파학회 (Korean Society Of Echocardiography)|2022.10|Journal of Cardiovascular Imaging|제30권 제4호|pp. 231-262

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TechnologyAortaCongenital abnormalitiesMultidetector computed tomography
주제분류내과학

초록

There is a wide spectrum of congenital anomalies or variations of the aortic arch, ranging from non-symptomatic variations that are mostly detected incidentally to clinically symptomatic variations that cause severe respiratory distress or esophageal compression. Some of these may be accompanied by other congenital heart diseases or chromosomal anomalies. The widespread use of multidetector computed tomography (CT) in clinical practice has resulted in incidental detection of several variations of the aortic arch in adults. Thus, radiologists and clinicians should be aware of the classification of aortic arch anomalies and carefully look for imaging features associated with a high risk of clinical symptoms. Understanding the embryological development of the aortic arch aids in the classification of various subtypes of aortic arch anomalies and variants. For accurate diagnosis and precise evaluation of aortic arch anomalies, cross-sectional imaging modalities, such as multidetector CT or magnetic resonance imaging, play an important role by providing three-dimensional reconstructed images. In this review, we describe the embryological development of the thoracic aorta and discuss variations and anomalies of the aortic arch along with their clinical implications.

Abstract

There is a wide spectrum of congenital anomalies or variations of the aortic arch, ranging from non-symptomatic variations that are mostly detected incidentally to clinically symptomatic variations that cause severe respiratory distress or esophageal compression. Some of these may be accompanied by other congenital heart diseases or chromosomal anomalies. The widespread use of multidetector computed tomography (CT) in clinical practice has resulted in incidental detection of several variations of the aortic arch in adults. Thus, radiologists and clinicians should be aware of the classification of aortic arch anomalies and carefully look for imaging features associated with a high risk of clinical symptoms. Understanding the embryological development of the aortic arch aids in the classification of various subtypes of aortic arch anomalies and variants. For accurate diagnosis and precise evaluation of aortic arch anomalies, cross-sectional imaging modalities, such as multidetector CT or magnetic resonance imaging, play an important role by providing three-dimensional reconstructed images. In this review, we describe the embryological development of the thoracic aorta and discuss variations and anomalies of the aortic arch along with their clinical implications.

참고문헌 (101)

  1. Goldmuntz E, "The epidemiology and genetics of congenital heart disease", Clin Perinatol, 28, pp.1~10 (2001)
  2. Kocis KC, "Aortic arch complex anomalies : 20-year experience with symptoms, diagnosis, associated cardiac defects, and surgical repair", Pediatr Cardiol, 18, pp.127~132 (1997)
  3. Jakanani GC, "Frequency of variations in aortic arch anatomy depicted on multidetector CT", Clin Radiol, 65, pp.481~487 (2010)
  4. Schleich JM, "Development of the human heart : days 15–21", Heart, 87, pp.487~ (2002)
  5. Kau T, "Aortic development and anomalies", Semin Intervent Radiol, 24, pp.141~152 (2007)
  6. Oshitani T, "A double-barrelled aorta with high aortic Arch", J Cardiol Cases, 24, pp.284~286 (2021)
  7. Edwards JE, "Anomalies of the derivatives of the aortic arch system", Med Clin North Am, 32, pp.925~949 (1948)
  8. Hanneman K, "Congenital variants and anomalies of the aortic arch", Radiographics, 37, pp.32~51 (2017)
  9. Stojanovska J, "Embryology and imaging review of aortic arch anomalies", J Thorac Imaging, 27, pp.73~84 (2012)
  10. Leonardi B, "Imaging modalities in children with vascular ring and pulmonary artery sling", Pediatr Pulmonol, 50, pp.781~788 (2015)
  11. Mądry W, "Methodology of echocardiographic analysis of morphological variations of the aortic arch and its branches in children-own experience", J Ultrason, 19, pp.24~42 (2019)
  12. Lee EY, "MDCT evaluation of thoracic aortic anomalies in pediatric patients and young adults : comparison of axial, multiplanar, and 3D images", AJR Am J Roentgenol, 182, pp.777~784 (2004)
  13. Aysel Turkvatan, "Congenital Anomalies of the Aortic Arch: Evaluation with the Use of Multidetector Computed Tomography", Korean Journal of Radiology, 10(2), pp.176~184 (2009), 대한영상의학회
  14. Lim HK, "Feasibility of high-pitch dual-source low-dose chest CT : reduction of radiation and cardiac artifacts", Diagn Interv Imaging, 97, pp.443~449 (2016)
  15. Ramos-Duran L, "Developmental aortic arch anomalies in infants and children assessed with CT angiography", AJR Am J Roentgenol, 198, pp.W466~W474 (2012)
  16. Bhalla AS, "Imaging protocols for CT chest : a recommendation", Indian J Radiol Imaging, 29, pp.236~246 (2019)
  17. Bae KT, "Optimization of contrast enhancement in thoracic MDCT", Radiol Clin North Am, 48, pp.9~29 (2010)
  18. Weininger M, "Cardiothoracic CT angiography : current contrast medium delivery strategies", AJR Am J Roentgenol, 196, pp.W260~W272 (2011)
  19. Chandra T, "Optimization of pediatric body CT angiography : what radiologists need to know", AJR Am J Roentgenol, 215, pp.726~735 (2020)
  20. Boxt LM, "Magnetic resonance and computed tomographic evaluation of congenital heart disease", J Magn Reson Imaging, 19, pp.827~847 (2004)
  21. Kellenberger CJ, "Aortic arch malformations", Pediatr Radiol, 40, pp.876~884 (2010)
  22. Natsis KI, "Anatomical variations in the branches of the human aortic arch in 633 angiographies : clinical significance and literature review", Surg Radiol Anat, 31, pp.319~323 (2009)
  23. Layton KF, "Bovine aortic arch variant in humans : clarification of a common misnomer", AJNR Am J Neuroradiol, 27, pp.1541~1542 (2006)
  24. Hornick M, "‘Bovine’ aortic arch-a marker for thoracic aortic disease", Cardiology, 123, pp.116~124 (2012)
  25. Nagpal P, "Modern imaging techniques : applications in the management of acute aortic pathologies", Postgrad Med J, 91, pp.449~462 (2015)
  26. Lacout A, "Vertebral arteria lusoria : a life-threatening condition for oesophageal surgery", Surg Radiol Anat, 34, pp.381~383 (2012)
  27. Yuan SM, "Aberrant origin of vertebral artery and its clinical implications", Rev Bras Cir Cardiovasc, 31, pp.52~59 (2016)
  28. Fawcett SL, "Anatomical variation in the position of the brachiocephalic trunk(innominate artery)with respect to the trachea : a computed tomography-based study and literature review of innominate artery compression syndrome", Clin Anat, 23, pp.61~69 (2010)
  29. Hasegawa T, "Innominate artery compression of the trachea in patients with neurological or neuromuscular disorders", Eur J Cardiothorac Surg, 45, pp.305~311 (2014)
  30. Abraham V, "Aberrant subclavian artery : anatomical curiosity or clinical entity", Int J Surg, 7, pp.106~109 (2009)
  31. Saeed G, "Arteria lusoria aneurysm with truncus bicaroticus : surgical resection without restoring blood supply to the right arm", Tex Heart Inst J, 37, pp.602~607 (2010)
  32. Janssen M, "Dysphagia lusoria : clinical aspects, manometric findings, diagnosis, and therapy", Am J Gastroenterol, 95, pp.1411~1416 (2000)
  33. Yunsuk Choi, "Prevalence and Anatomy of Aberrant Right Subclavian Artery Evaluated by Computed Tomographic Angiography at a Single Institution in Korea", 대한신경외과학회지, 62(2), pp.175~182 (2019), 대한신경외과학회[DOI]
  34. Tsai IC, "Vertebral and carotid artery anomalies in patients with aberrant right subclavian arteries", Pediatr Radiol, 37, pp.1007~1012 (2007)
  35. Scala C, "Aberrant right subclavian artery in fetuses with Down syndrome : a systematic review and meta-analysis", Ultrasound Obstet Gynecol, 46, pp.266~276 (2015)
  36. Vistarini N, "Aberrant subclavian artery as origin of aortic dissection", Eur J Cardiothorac Surg, 34, pp.1109~ (2008)
  37. Monica Leon, "Hybrid Treatment of Aberrant Right Subclavian Artery Causing Dysphagia Lusoria by Subclavian to Carotid Transposition and Endovascular Plug", Vascular Specialist International, 36(4), pp.258~262 (2020), 대한혈관외과학회[DOI]
  38. van Rosendael PJ, "The clinical spectrum of Kommerell’s diverticulum in adults with a right-sided aortic arch : a case series and literature overview", J Cardiovasc Dev Dis, 8, pp.25~ (2021)
  39. Priya S, "Congenital anomalies of the aortic arch", Cardiovasc Diagn Ther, 8(Suppl 1), pp.S26~S44 (2018)
  40. Poterucha J, "Incidence and clinical presentation of Kommerell diverticulum", J Am Coll Cardiol, 65, pp.A524~ (2015)
  41. Ota T, "Surgical treatment for Kommerell’s diverticulum", J Thorac Cardiovasc Surg, 131, pp.574~578 (2006)
  42. Konstantinov IE, "Isolated subclavian artery : anatomical and surgical considerations", Ann Thorac Surg, 88, pp.1685~1687 (2009)
  43. Sen S, "Isolated subclavian artery : a rare entity revisited", World J Pediatr Congenit Heart Surg, 7, pp.744~749 (2016)
  44. Maya I, "Chromosomal microarray analysis in fetuses with aberrant right subclavian artery", Ultrasound Obstet Gynecol, 49, pp.337~341 (2017)
  45. Bech AP, "Isolation of the left subclavian artery from the pulmonary artery in a patient with CHARGE association", Congenit Anom(Kyoto), 50, pp.200~202 (2010)
  46. Haranal M, "Circumflex aorta : an uncharted territory", Asian Cardiovasc Thorac Ann, 30, pp.217~225 (2022)
  47. Kamran A, "Aortic uncrossing and tracheobronchopexy corrects tracheal compression and tracheobronchomalacia associated with circumflex aortic arch", J Thorac Cardiovasc Surg, 160, pp.796~804 (2020)
  48. Arazińska A, "Right aortic arch analysis-Anatomical variant or serious vascular defect?", BMC Cardiovasc Disord, 17, pp.102~ (2017)
  49. Jin ZW, "Pathogenesis of solitary right aortic arch : a mass effect hypothesis based on observations of serial human embryonic sections", Cardiol Young, 27, pp.359~368 (2017)
  50. Shuford WH, "The three types of right aortic arch", Am J Roentgenol Radium Ther Nucl Med, 109, pp.67~74 (1970)
  51. 하근진, "A Case of Right Sided Aortic Arch Combined with Atrial Septal Defect", Journal of Cardiovascular Imaging, 19(1), pp.32~34 (2011), 한국심초음파학회
  52. Garti IJ, "Right aortic arch with mirror-image branching causing vascular ring. A new classification of the right aortic arch patterns", Br J Radiol, 46, pp.115~119 (1973)
  53. McElhinney DB, "Patterns of right aortic arch and mirror-image branching of the brachiocephalic vessels without associated anomalies", Pediatr Cardiol, 22, pp.285~291 (2001)
  54. Kanne JP, "Right aortic arch and its variants", J Cardiovasc Comput Tomogr, 4, pp.293~300 (2010)
  55. Cantinotti M, "Diagnostic role of magnetic resonance imaging in identifying aortic arch anomalies", Congenit Heart Dis, 3, pp.117~123 (2008)
  56. McElhinney DB, "Association of chromosome 22q11 deletion with isolated anomalies of aortic arch laterality and branching", J Am Coll Cardiol, 37, pp.2114~2119 (2001)
  57. van Son JA, "Burckhard F. Kommerell and Kommerell’s diverticulum", Tex Heart Inst J, 29, pp.109~112 (2002)
  58. Backer CL, "Congenital Heart Surgery Nomenclature and Database Project : patent ductus arteriosus, coarctation of the aorta, interrupted aortic arch", Ann Thorac Surg, 69(Suppl), pp.S298~S307 (2000)
  59. Faistauer Â, "Right aortic arch with aberrant left innominate artery arising from Kommerell’s diverticulum", Radiol Bras, 49, pp.264~266 (2016)
  60. Karangelis D, "The aberrant subclavian artery : approach to management", Curr Opin Cardiol, 35, pp.636~642 (2020)
  61. Sun AM, "MRI diagnosis of isolated origin of the left subclavian artery from the left pulmonary artery", Pediatr Radiol, 35, pp.1259~1262 (2005)
  62. Shuford WH, "Right aortic arch with isolation of the left subclavian artery", Am J Roentgenol Radium Ther Nucl Med, 109, pp.75~83 (1970)
  63. Arnoult AC, "Late discovery of a rare anomaly of the right aortic arch and an isolated left subclavian artery", J Vasc Surg, 64, pp.1853~1854 (2016)
  64. Fenández-Tena A, "Double aortic arch diagnosed in a 44-year-old woman with recurring respiratory infections", Respir Med Case Rep, 20, pp.176~178 (2017)
  65. Schlesinger AE, "Incomplete double aortic arch with atresia of the distal left arch : distinctive imaging appearance", AJR Am J Roentgenol, 184, pp.1634~1639 (2005)
  66. Dillman JR, "Common and uncommon vascular rings and slings : a multi-modality review", Pediatr Radiol, 41, pp.1440~1454 (2011)
  67. Newman B, "MR of right aortic arch", Pediatr Radiol, 26, pp.367~369 (1996)
  68. Holmes KW, "Magnetic resonance imaging of a distorted left subclavian artery course : an important clue to an unusual type of double aortic arch", Pediatr Cardiol, 27, pp.316~320 (2006)
  69. Alsenaidi K, "Management and outcomes of double aortic arch in 81 patients", Pediatrics, 118, pp.e1336~e1341 (2006)
  70. Yang Y, "Diagnosis and surgical repair of congenital double aortic arch in infants", J Cardiothorac Surg, 14, pp.160~ (2019)
  71. Poellinger A, "Images in cardiovascular medicine. The cervical aortic arch : a rare vascular anomaly", Circulation, 117, pp.2716~2717 (2008)
  72. Pearson GD, "Cervical aortic arch with aneurysm formation", Am J Cardiol, 79, pp.112~114 (1997)
  73. Ilyas M, "Cervical aortic arch-when the aorta gets high", Indian J Thorac Cardiovasc Surg, 34, pp.521~524 (2018)
  74. Zhong YL, "Surgical repair of cervical aortic arch : an alternative classification scheme based on experience in 35 patients", J Thorac Cardiovasc Surg, 159, pp.2202~2213 (2020)
  75. Van Praagh R, "Persistent fifth arterial arch in man. Congenital double-lumen aortic arch", Am J Cardiol, 24, pp.279~282 (1969)
  76. Liu Y, "Persistent fifth aortic arch : a single-center experience, case series", Transl Pediatr, 10, pp.1566~1572 (2021)
  77. Al Akhfash AA, "Persistent fifth aortic arch diagnosed by echocardiography and confirmed by angiography : case report and literature review", J Saudi Heart Assoc, 21, pp.245~248 (2009)
  78. Hwang MS, "Isolated persistent fifth aortic arch with systemic-to-pulmonary arterial connection", J Thorac Cardiovasc Surg, 126, pp.1643~1644 (2003)
  79. 김수현, "Persistent Fifth Aortic Arch with Coarctation", Journal of Chest Surgery, 49(1), pp.39~41 (2016), 대한심장혈관흉부외과학회
  80. Newman B, "Persistent fifth arch anomalies-broadening the spectrum to include a variation of double aortic arch vascular ring", Pediatr Radiol, 46, pp.1866~1872 (2016)
  81. Varghese A, "Images in cardiovascular medicine : Magnetic resonance angiography of a congenitally interrupted aortic arch", Circulation, 106, pp.E9~E10 (2002)
  82. Dillman JR, "Interrupted aortic arch : spectrum of MRI findings", AJR Am J Roentgenol, 190, pp.1467~1474 (2008)
  83. Schreiber C, "The interrupted aortic arch : an overview after 20 years of surgical treatment", Eur J Cardiothorac Surg, 12, pp.466~469 (1997)
  84. Chan FP, "Computed tomography and magnetic resonance imaging in neonates with congenital cardiovascular disease", Semin Ultrasound CT MR, 36, pp.146~160 (2015)
  85. Westaby S, "Repair of type B interrupted aortic arch using aberrant right subclavian artery", Interact Cardiovasc Thorac Surg, 9, pp.528~529 (2009)
  86. Abdoli S, "Type B aortic arch interruption in an adult", Ann Thorac Surg, 102, pp.e431~e432 (2016)
  87. Patel DM, "Interrupted aortic arch with post-interruption aneurysm and bicuspid aortic valve in an adult : a case report and literature review", Radiol Case Rep, 10, pp.5~8 (2015)
  88. Volpe P, "Prenatal diagnosis of interruption of the aortic arch and its association with deletion of chromosome 22q11", Ultrasound Obstet Gynecol, 20, pp.327~331 (2002)
  89. Gruber PJ, "Development gone awry : congenital heart disease", Circ Res, 94, pp.273~283 (2004)
  90. Jonas RA, "Management of interrupted aortic arch", Semin Thorac Cardiovasc Surg, 27, pp.177~188 (2015)
  91. Brown JW, "Transverse aortic arch obstruction : when to go from the front", Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 12, pp.66~69 (2009)
  92. Onalan MA, "Management of aortic arch hypoplasia in neonates and infants", J Card Surg, 36, pp.124~133 (2021)
  93. Kenny D, "Coarctation of the aorta : from fetal life to adulthood", Cardiol J, 18, pp.487~495 (2011)
  94. Agasthi P, "Management of adults with coarctation of aorta", World J Cardiol, 12, pp.167~191 (2020)
  95. Dodge-Khatami A, "Carotid-subclavian artery index : new echocardiographic index to detect coarctation in neonates and infants", Ann Thorac Surg, 80, pp.1652~1657 (2005)
  96. Karaosmanoglu AD, "CT and MRI of aortic coarctation : pre-and postsurgical findings", AJR Am J Roentgenol, 204, pp.W224~W233 (2015)
  97. Dijkema EJ, "Diagnosis, imaging and clinical management of aortic coarctation", Heart, 103, pp.1148~1155 (2017)
  98. Eckhauser A, "Turner syndrome in girls presenting with coarctation of the aorta", J Pediatr, 167, pp.1062~1066 (2015)
  99. Prada F, "Complex aortic coarctation and PHACE syndrome", Rev Esp Cardiol, 63, pp.1367~1370 (2010)
  100. Aslam S, "Shone complex : an under-recognized congenital heart disease with substantial morbidity in adulthood", Can J Cardiol, 33, pp.253~259 (2017)
  101. Doshi AR, "Coarctation of aorta in children", Cureus, 10, pp.e3690~ (2018)

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