International Journal of Cardiovascular and Thoracic Surgery
Volume 4, Issue 4, July 2018, Pages: 34-38
Received: Aug. 6, 2018;
Accepted: Sep. 10, 2018;
Published: Oct. 10, 2018
Views 796 Downloads 71
Cornelia Sonia Carr, Department of Cardiothoracic Surgery, Heart Hospital, Doha, Qatar
Shady Ashraf Mohammed, Department of Cardiothoracic Surgery, Heart Hospital, Doha, Qatar
Nazar Mohammed, Department of Cardiology, Heart Hospital, Doha, Qatar
Lama Shuayb, Qatar Cardiovascular Research Centre, Doha, Qatar
Maryam Eissa Alkuwari, Department of Radiology, Heart Hospital, Doha, Qatar
Abdulaziz Mohammed Alkhulaifi, Department of Cardiothoracic Surgery, Heart Hospital, Doha, Qatar
The aortic arch and its branches form during the third week of embryogenesis. The most common human pattern has the innominate artery, the left common carotid artery and the left subclavian artery all as separate branches. Large imaging studies have shown 70% of people have a normal branching pattern with 20% having a common origin of the innominate artery and left common carotid artery, but these studies were performed without reference to the anatomy of the aortic valve (bicuspid versus tricuspid).Bicuspid aortic valve (BAV) is the commonest congenital cardiac malformation and as the arch branching patterns are developmental in origin we decided to see if the frequency of arch variants in BAV and tricuspid aortic valve (TAV) patients differed, as this has not previously been looked at. We examined Computerised Tomographic aortograms and echocardiograms of BAV and TAV patients to assess the aortic arch branching pattern and any possible association with the valve morphology. 28 BAV and 57 TAV patients were assessed. For BAV the branching patterns were: 86% normal (24/28) and 14% abnormal (4/28), and for TAV: 70% normal (40/57) and 30% abnormal (17/57). Although this is a small study our TAV group demonstrated comparable normal/abnormal arch variants as the published literature, but the BAV group appears to have fewer arch variants. This is the first study in the literature to look at the arch branching variants when consideration of the aortic valve morphology (BAV versus TAV) is taken into account.
Cornelia Sonia Carr,
Shady Ashraf Mohammed,
Maryam Eissa Alkuwari,
Abdulaziz Mohammed Alkhulaifi,
Aortic Arch Branching Patterns in Bicuspid and Tricuspid Aortic Valve Patients, International Journal of Cardiovascular and Thoracic Surgery.
Vol. 4, No. 4,
2018, pp. 34-38.
Kau T, Sinzig M, Gasser J, Lesnik G, Rabitsch E, Celedin S, Eicher W, Illiasch H, Hausegger KA. Aortic Development and Anomalies. Semin Intervent Radiol 2007;24(2):141-152.
Layton KF, Kallmes DF, Cloft HJ, Lindell EP, Cox VS. Bovine aortic arch variant in humans: clarification of a common misnomer. American Journal of Neuroradiol 2006;27:1541-42.
N. shakuntala Rao, k. Sujatha, K Meera, H.R. Krishna Rao. A comparative study on the structure and functions of aorta in man and ruminant animals. International Journal of Anatomy and Research, Int J Anat Res 2016, Vol 4(4):3194-98.
Jakanani GC, Adair W. Frequency of variations in aortic arch anatomy depicted on multidetector CT. Clinical Radiology 2010;65:481-487.
Shakeri A, Pourisa M, Deldar A, Goldust M. Anatomic variations of aortic arch branches and relationship with diameter of aortic arch by 64-row CT angiography. Pak J Biol Sci 2013;16(10):496-500.
Nistri S, Basso C, Marzari C, Mormino P, Thiene G. Frequency of bicuspid aortic valve in young male conscripts by echocardiogram. Am J Cardiology. 2005;96(5):718-721.
Mahadevia R, Barker AJ, Schnell S, Entezari P, Kansal P, Fedak PW, Malaisrie SC, McCarthy P, Collins J, Carr J, Markl M. Bicuspid aortic cusp fusion morphology alters aortic three-dimensional outflow patterns, wall shear stress, and expression or aortopathy. Circ 2014;129(6):673-82.
Phillippi JA, Green BR, Eskay MA, Kotlarczyk MP, Hill MR, Robertson AM, Watkins SC, Vorp DA, Gleason TG. Mechanism of aortic medial matrix remodeling is distinct in patients with bicuspid aortic valveJ Thorac Cardiovasc Surg 2014;147(3):1056-64.
Michelena HI, Khanna AD, Mahoney D, Margaryan E, Topilsky Y, Suri RM, Eidem B, Edwards WD, Sundt TM 3rd, Enriquez-Sarano M. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA 2011;306(10):1104-12.
Eleid MF, Forde I, Edwards WD, Maleszewski JJ, Suri RM, Schaff HV, Enriquez-Sarano M, Michelena HI. Type A aortic dissection in patients with bicuspid aortic valves: clinical and pathological comparison with tricuspid aortic valves. Heart 2013;99(22):1668-74.
Fazel SS, Mallidi HR, Lee RS, Sheehan MP, Laing D, Fleischman D, Herfkens R, Mitchell RS, Miller DC. The aortopathy of bicuspid aortic valve disease has distinctive patterns and usually involves the transverse aortic arch. The Journal of Thoracic and Cardiovascular Surgery 2008;135:901-7.
Moore KL, Persaud TV. The developing human: clinically oriented embryology. 8th ed. Philadelphia: Saunders Elsevier; 2008. pp. 305–306.pp. 316–325.
Sadler TW. Langman's medical embryology. 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2006. pp. 173–175.pp. 180–185.
Nelson ML, Sparks CD. Unusual aortic arch variation: distal origin of common carotid arteries. Clin Anat. 2001;14:62–65. [PubMed].
Satyapal KS, Singaram S, Partab P, Kalideen JM, Robbs JV. Aortic arch branch variations: case report and arteriographic analysis. S Afr J Surg. 2003;41:48–50.
Dr Sachintha Hapugoda and A.Prof Frank Gaillardet al. Aortic arch. www.radiopaedia.org.
Julia Dumfarth, Alan S. Chou BA, Bulat A. Ziganshin et all. Atypical aortic arch branching variants: A novel marker for thoracic aortic disease. The journal of thoracic and cardiovascular surgery Volume 149, Issue 6. June 2015, Pages 1586-1592.
K.M. Wanamaker, C.C. Amadi, J.S. Mueller, R.J. Moraca. Incidence of aortic arch anomalies in patients with thoracic aortic dissections. J Card Surg, 28 (2013), pp. 151-154.