Ultraschall in Med : 
DOI: 10.1055/s-0031-1273472
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Altered Cerebral Collateralization in Patients with Left Brachiocephalic Trunk Occlusion and a Right Descending Aorta

Besonderheiten der Kollateralisation bei Patienten mit Verschluss des linken Truncus brachiocephalicus und rechts deszendierender AortaM. Ertl, G. Schuierer, U. Bogdahn, F. Schlachetzki
Further Information

Publication History

received: 12.1.2011

accepted: 24.5.2011

Publication Date:
25 August 2011 (eFirst)

Introduction

A right aortic arch with a left brachiocephalic trunk is a very rare abnormality in the development of the aortic arch and its branches. It accounts for only 0.1 % of all aortic arch abnormalities and is associated in 95 % of all cases with cyanotic heart diseases. At a young age, the latter patients often exhibit pectanginal symptoms (Das SK et al. Byrom Eur J Vasc Endovasc Surg 2005; 30: 48 – 51). The clinical presentation of the remaining 5 % is non-specific and can result in a subclavian steal syndrome. An association with a patent ductus arteriosus, a left brachiocephalic trunk or other cardiac abnormalities is very common (Singh B. Clin Anat 2001; 14: 47 – 51). In the case of occlusion of the left brachiocephalic trunk, reactivation of embryonic segmental arteries may result in atypical patterns of collateral vessel pathways with altered cerebrovascular hemodynamics.

In this paper we employ a battery of noninvasive neuroimaging techniques, color-coded duplex sonography, magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) to characterize the hemodynamic situation in two patients with occlusion of an isolated left brachiocephalic artery, a right aortic arch and extensive segmental collateral vessel formations.