This video illustrates surgical repair of double aortic arch through a sternotomy. Double aortic arch is the most common type of vascular ring malformation. It involves complete encirclement of the trachea and esophagus by the aortic arch or its branches.
There are three types of double aortic arch: 80 percent are dominant right arches, 10 percent are dominant left arches, and 10 percent are balanced arches.
In this case, the patient was a two-month-old, 5 kg boy with shortness of breath, stridor, and difficulty swallowing. A CT scan revealed double aortic arch and compression of the esophagus and trachea. The descending aorta was on left side of the spine and right arch was dominant. Surgeons decided to divide the left arch through a sternotomy.
After median sternotomy, the anatomy was inspected, showing the right subclavian artery and right carotid artery arising from the right arch. There was also a patent ductus arteriosus between the left arch and main pulmonary artery. The left subclavian artery and left carotid artery were arising from the left arch.
To begin the procedure, the ascending aorta, descending aorta, left and right subclavian arteries, and left and right carotid arteries were dissected free and looped. The PDA was then divided between two Hemoclips. The left arch was then transfixed with 6-0 Prolene suture just below the left subclavian artery and the left isthmus was clamped and the left arch was divided. The proximal end was secured with 6-0 Prolene sutures. Remnants of the PDA were resected, and the left isthmus was secured with 6-0 Prolene in two layers. Finally, the adhesive bands surrounding the esophagus were divided.
The patient was extubated in the operating room and is still being followed in ICU because of severe stridor and shortness of breath.
References
- Tarmahomed A, Umapathi KK. Double Aortic Arch. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558934/
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