Right cervical aortic arch with subaortic left brachiocephalic vein: MRI findings

A case of a right cervical aortic arch associated with a subaortic left brachiocephalic vein is reported. CT and MRI findings were correlated to the angiogram. The mechanism responsible for the coexistence of these two abnormalities is discussed. Correspondence to: C. Beigelman     

Right aortic arch with isolation of the left innominate artery

Isolation of the left innominate artery and right aortic arch, a rare variant of right aortic arch anomalies, was diagnosed in a four-year-old boy with other congenital cardiac anomalies. Isolation of vessels from the aortic arch is predicted from the primitive double aortic arch model of Edwards. In this patient there was no evidence of a vascular ring or of a significant subclavian steal syndrome.     

Serial aortography assesses stability of “Atypical” aortic arch ruptures

The victim of a high speed motor vehicle accident sustained an ascending aortic laceration as well as avulsion of the left subclavian artery. Initial management of the tears was conservative. The case is typical of “atypical” aortic arch tears except that the patient survived without emergent surgery. Serial aortography proved useful in assessing stability of the tears, providing opportunity to observe the natural history of these injuries angiographically. The distribution of aortic arch injuries following blunt trauma is reviewed.     

Congenital subclavian steal associated with an unusual type of right aortic arch

A case of congenital subclavian steal caused by a previously unreported aortic arch anomaly was demonstrated by angiography. The patient was shown to have a right aortic arch with a retroesophageal segment, a stenotic proximal portion of the left subclavian artery, and a left descending aorta.     

Three aortic arch anomalies: A review of the literature and proposal of a new classification

Four patients with three rare aortic arch anomalies, all of which can be classified as variants of Edwards' hypothetical double aortic arch system, were studied. The diagnosis was based on angiographic findings in all cases and in addition, on operative findings in three and operative and autopsy findings in one case. All normal and anomalous variants of aortic arches may be incorporated into a new classification based upon Edwards' hypothetical double aortic arch system. In the new classification the term double aortic arch with types A, B, C, or D atresia or interruption of the left or the right arch covers all known arch anomalies. The types A, B, C, and D refer to the site of atresia or interruption of the hypothetical double aortic arch model in relationship to the ductus arteriosus and brachiocephalic vessels.     

Right ventricular cineangiography in tetralogy of Fallot

Accurate delineation of the anatomy of the cardiac chambers and the pulmonary vessels is a neccessary component of the preoperative workup in Fallot's tetralogy. Selective right ventriculograms in shallow right anterior oblique and steep left anterior oblique views were used in the evaluation of 65 cases. Our observations indicate that these views display the anatomy of Fallot's tetralogy to a better advantage than do the conventional anteroposterior and lateral views.     

Right-side aortic arch with aneurysm of aberrant left subclavian artery: MR imaging appearance.

Reports of aneurysms of the subclavian artery in both normal and anomalous aortic arches have been rare. The authors describe a patient with a right-side aortic arch and an aneurysm of the aberrant left subclavian artery, which, to the authors' knowledge, is a previously unreported association. At presentation, the aneurysm appeared as a calcified left superior mediastinal mass. Magnetic resonance imaging enabled preoperative diagnosis and guided surgical planning.     

Digital subtraction angiography of the aortic arch

We evaluated the utility of intravenous digital subtraction angiography (IV DSA) for diagnosing lesions of the aortic arch and great vessels in 25 patients. Digital subtraction angiography (DSA) was found useful in evaluating congenital and acquired lesions of the arch and great vessel origins, and it proved adequate for follow-up of patients who had graft replacement. Cases examined included: right aortic arch, double arch, aortic coarctation, aberrant vascular origins, aortic aneurysm and pseudoaneurysm, changes in atherosclerotic great vessels, and revascularization procedures for patients with pulmonary atresia and aortic interruption. In our experience, DSA is a useful tool for screening and following patients with aortic arch or great vessel lesions; it is often the only diagnostic imaging examination necessary.     

Double aortic arch associated with pulmonary sequestration

Double aortic arch and pulmonary sequestration, both uncommon vascular malformations, were seen in a six-month-old infant. The diagnosis was made by angiography, and successful surgical correction of both lesions was performed.     

Use of through-and-through guidewire for delivering large stent-grafts into the distal aortic arch

The availability of large diameter stent-grafts is now allowing the endovascular treatment of thoracic aortic aneurysms. Most aneurysms are closely related to the distal arch and it is thus necessary to pass the delivery systems into the arch to effectively cover the proximal neck. Even with extra-stiff guidewires in position, it may still be difficult to achieve this, as a result of tortuosity at the iliac arteries and the aorta. We detail a technique where a stiff guidewire is passed from a brachial entry point through the aorta and out at the femoral arteriotomy site. This allows extra-support and may enable the delivery system to be passed further into the aortic arch than it could with just the regular guidewire position.     

磁共振EC TRICKS序列与DSA在主动脉弓分支血管病变中的对比研究

目的：探讨椭圆中心时间决定对比剂动态成像法（EC TRICKS）与数字减影血管造影（DSA）在主动脉弓分支血管病变诊断中的应用价值。方法：搜集本院83例患者资料,分别应用GE Signa HD1.5T磁共振仪及GE Advantx LC DSA机器,对全部患者主动脉弓分支血管行EC TRICKS及DSA成像,EC TRICKS后处理利用多平面重组及最大信号强度投影技术对原始图像进行血管重现。结果：EC TRICKS扫描,83例中有82例主动脉弓分支血管显示良好符合诊断要求,1例检查失败,DSA全部病例显影良好。依是否存在狭窄为标准,82例EC TRICKS诊断结果与DSA保持良好一致性。其中右侧锁骨下动脉狭窄5例,左侧锁骨下动脉狭窄14例;左、右侧椎动脉狭窄各17例;颈总动脉狭窄左侧31例,右侧24例;颈内动脉狭窄左侧32例,右侧20例;无名动脉狭窄11例。结论：ECTRICKS能无创性的清晰显示主动脉弓分支血管走行及管腔狭窄程度,为临床医生提供准确的诊断定位及治疗依据。     

64层螺旋CT低剂量对比剂主动脉成像的可行性研究

目的：探讨64层螺旋C T主动脉血管成像中使用低剂量对比剂的可行性。方法60例主动脉血管成像患者,随机分为A、B、C三组：A组对比剂量80ml＋生理盐水20ml冲洗;B组对比剂量70ml＋生理盐水30ml冲洗;C组对比剂量60ml＋生理盐水40ml冲洗。注射速率均为5ml/s ,扫描延迟时间采用自动触发技术。原始数据均传至工作站,进行图像重组,并测量升主动脉、T7及L2水平降主动脉、主动脉分叉处CT 值。由主治医师及副主任医师各一名共同阅片,对血管强化程度、主要分支血管显示清晰度进行评价。结果 A、B、C三组血管强化程度、主要分支血管显示清晰度均无统计学差异。结论在64层螺旋CT主动脉血管成像中,应用低剂量对比剂60ml＋生理盐水40ml冲洗,图像质量满意,可以满足临床诊断要求。     

急性主动脉壁间血肿的多层螺旋CT血管造影影像学表现和诊断价值

目的探讨急性主动脉壁间血肿（AAIH）的多层螺旋CT血管造影（MSCTA）影像学特征和临床应用价值。方法回顾性分析临床确诊76例AAIH患者的主动脉MSCTA检查资料,依据Stanford分型分为A型和B型,比较不同Stanford分型AAIH的影像学表现有无差异。根据患者随访期间的不同变化分为进展组与稳定和缓解组,分析进展的相关因素。所有结果均行统计学分析,符合正态分布的定量资料采用两独立样本t检验;不符合正态分布的定量资料采用Mann-Whitney U检验。定性资料采用χ2检验。结果Stanford A型27例（35.5%）、B型49例（64.5%）。A型、B型壁间血肿最大厚度、溃疡类病变、局灶性强化、胸腔积液上的差异均无统计学意义（Z=-0.788、χ2=0.441、χ2=0.383、χ2=0.338,均P > 0.05）。A型、B型溃疡类病变的深度分别为（2.8±2.9）mm、（2.5±3.3）mm,差异有统计学意义（Z=-2.345,P=0.019）。心包积液15例（19.7%）,A型12例多于B型3例,差异有统计学意义（χ2=16.138,P < 0.001）。41例AAIH患者短期随访,进展组20例,稳定和缓解组21例。单因素分析显示,进展组与稳定和缓解组在溃疡类病变、溃疡深度、胸腔积液间的差异均具有统计学意义（χ2=9.227、Z=-2.689、χ2=4.111,均P < 0.05）;在Stanford分型、壁间血肿厚度、局灶性强化、心包积液上的差异均无统计学意义（χ2=1.453、Z=-0.874、χ2=0.006、χ2=1.733,均P > 0.05）。将单因素分析中有统计学意义的指标纳入多因素Logistic回归分析,显示溃疡类病变是影响AAIH的独立危险预测因子。结论AAIH在MSCTA上表现为平扫密度较高、增强无强化的环形或新月形增厚主动脉管壁。MSCTA检查可以对AAIH做出快速、准确诊断。溃疡性病变是影响AAIH进展的独立危险因素。AAIH早期需要密切随访,监测有无进展。     

Blalock-Taussig shunt to a pulmonary vein: An unusual surgical complication

Thickening of the wall of pulmonary veins in cyanotic congenital heart disease and the presence of hilar vessel anatomic variants may mislead a surgeon into incorrectly anastomosing the subclavian artery to the pulmonary vein when performing a Blalock-Tassig shunt. Emergency selective angiography is the study of choice for the identification of this operative complication.     

Unusual manifestations of aortic dissection

Two unusual manifestations of aortic dissection, rupture into the main pulmonary artery and rupture into the inferior vena cava, are presented. The latter complication has not been reported previously in the literature. The value of inferior vena caval oximetry to delineate the site of fistulous communication is stressed.     

Computed tomographic demonstration of aortic transection at the diaphragmatic hiatus

A rare case of dissection of the descending aorta at the level of the diaphragmatic hiatus is presented.     

Angiography and magnetic resonance imaging of aortic dissection

This review article describes and illustrates the role of angiography and magnetic resonance imaging in the evaluation of aortic dissection. Clinical findings, complications, classification, and treatment of dissection are reviewed as well.     

非梗阻性先天性主动脉弓畸形的增强MR血管造影和心血管造影诊断

目的 报道115例非梗阻性先天性主动脉弓畸形，评估心血管造影和增强磁共振血管造影术（CE MRA）等影像诊断方法的价值。方法 115例先天性主动脉弓畸形单经心血管造影诊断106例，单经CE MRA诊断2例，经上述2种方法诊断7例。结果 115例中，双主动脉弓5例，右位主动脉弓迷走左锁骨下动脉45例，左位主动脉弓迷走右锁肌下动脉33例，右弓孤立左锁骨下动脉11例，右弓左降7例，左弓右降4例，颈主动脉弓4例，其他6例。7例同时做了心血管造影与CE MRA检查的患者2种方法诊断结果均相互符合。2例只做了MRA的病例中有1例为颈主动脉弓，另1例为右位主动脉弓迷走左锁骨下动脉。结论 造影增强MRA是可靠的非创伤性诊断手段。     

320排容积CT三种心电扫描模式在胸腹主动脉CTA中的应用

目的探讨320排容积CT胸腹主动脉成像（CT angiography,CTA）在三种心电扫描模式下的图像质量及辐射剂量,为患者提供个性化扫描方案。方法183例疑似主动脉疾病患者随机分为三组。采用前瞻Wide-Volume扫描（A组）;前瞻性心电门控螺旋扫描（B组）;VHP扫描（可变螺距螺旋扫描）（C组）。每组再根据心率分成两个亚组,亚组1心率〉70次／min,亚组2心率〈70次／min。获得的6组图像数据分别进行图像处理,由2名有经验的放射科医师评价图像质量并进行统计学分析。结果183例患者全部获得满意图像质量。三组中,前瞻性心电门控螺旋扫描获图像质量最佳（主动脉评分-x=1．04分;冠状动脉评分-x=1．18分）,辐射剂量最低（-x=13．62mSv）,在低心率组（〈70次／rain）扫描时间最短（-x=14．1s）;前瞻Wide-Volume扫描在高心率组（〉70次／min）扫描时间最短（-x=14．5s）;VHP扫描辐射剂量最高（-x=24．04mSv）。各组间对比剂用量差异无统计学意义（A组-x=78．1ml;B组-x=79．6ml;C组-x=80．2ml,P〉O．05）。结论前瞻性心电门控螺旋扫描适用较低心率患者（心率〈70次／min）,前瞻Wide-Volume扫描适用于较高心率患者（心率〉70次／min）,VHP扫描辐射剂量较高,对比前两种方法无明显优势。     

Percutaneous transluminal aortic angioplasty: Early and late results

Percutaneous transluminal angioplasty of the infrarenal abdominal aorta (13 patients) and its bifurcation (15 patients) was performed in 28 patients with a total of 32 dilatation procedures. The group consisted of 16 female and 12 male patients and initial successful dilatation was achieved in all Recurrence within 1 month requiring bypass surgery occurred in 1 patient. Three patients were lost to follow-up. Long-term follow-up in the remaining 24 patients ranged from 1 to 9 years with a mean of 4.5 years. During the follow-up period, repeat angioplasty of the original stenosis was performed in 3 patients and another patient underwent dilatation of a new lesion which developed in the aorta. According to clinical and noninvasive studies, these 4 patients, as well as the other 20, have maintained patency of the treated lesions and are symptom free. No immediate complications requiring surgery occurred. We conclude that angioplasty is the initial treatment of choice in focal lesions of the distal abdominal aorta and its bifurcation.