Author + information
- Received July 20, 2018
- Accepted August 30, 2018
- Published online October 31, 2018.
- Yusuke Sato, MD,
- Tetsuji Morishita, MD, PhD∗ (, )
- Hiroyasu Uzui, MD, PhD and
- Hiroshi Tada, MD, PhD
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
- ↵∗Address for correspondence:
Dr. Tetsuji Morishita, Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
A 77-year-old man was admitted to our hospital with chest pain and acute heart failure. The electrocardiogram exhibited ST-segment changes in the precordial leads, and transthoracic echocardiography revealed severe anterior-septal wall hypokinesis. A chest x-ray demonstrated a right-deviated aorta (Figure 1A). Coronary computed tomography angiography (CTA) revealed a double aortic arch (DAA) and right descending aorta, combined with severe left anterior descending artery stenosis. The aorta, after crossing retroesophageally, turned sharply back to the left and caudally, descending on the left (Figures 1B to 1F, Online Video 1). The right aortic arch was normal size and served as the main systemic channel, whereas the left persisted as a partially obliterated tube. Determining the approach site was the therapeutic challenge in this patient. Femoral and left radial approaches were not available because of severe descending aorta tortuosity and an obliterated left aortic arch. A right transradial approach was chosen for percutaneous coronary intervention (PCI) because the right aortic arch served as the main channel. The patient underwent an uneventful PCI (Figures 1G to 1I).
A double aortic arch (DAA) is a very rare congenital malformation characterized by the presence of 2 aortic arches. To the best of our knowledge, this is the first case of PCI using CTA in a DAA with a right descending aorta. Three-dimensional CTA established the DAA diagnosis and enabled an exact description of the anatomy and comprehensive understanding of the vascular rings, which were essential for pre-PCI planning.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 20, 2018.
- Accepted August 30, 2018.
- 2018 American College of Cardiology Foundation