[A case report of ventricular septal defect accompanied by winded and elongated malformation of the aortic arch].
A three-year-old boy, surgically treated for a ventricular septal defect, had a winded and elongated aortic arch between the left common carotid artery and the left subclavian artery. Angiography revealed that the arch was positioned more caudalward than normally, and that it was in contact with the left pulmonary artery at a point near the central portion of the arch (i.e., near the position of the ductus arteriosus). The embryological cause of this malformation was speculated. It seemed unlikely that malformations was caused by involution, abnormal growth, etc., of the components of the great vessels in the coursed of embryonic development, but rather to have been caused by an abnormal elongation of the artery at the fourth arch and of the ventral artery between the 6th and 7th intersegmental artery, which had occurred after normal embryonic development. Under extracorporeal circulation, where blood was returned to the patient via the femoral artery, the patient underwent open heart surgery to close the ventricular septal defect. Pressure monitoring during the operation revealed no pressure loss in the winded and elongated portion of the artery; hence, the malformation seemed to cause no hemodynamic problems at present. Considering that the patient is only three years old and that the aorta will continue to grow, we have decided to refrain from any surgical treatment of the winded and alongated part of the aorta for the time being. However, the patient might develop aortic aneurysm in the future because of the relative coactation of the aorta and the insufficient mechanical strength of the winded and elongated area.(ABSTRACT TRUNCATED AT 250 WORDS)
Tabata
R
R
Watarida
S
S
Onoe
M
M
Siraishi
S
S
Mori
A
A
Hatsutori
M
M
D001013:Aorta, Thoracic / Q000002:abnormalities*; D002675:Child, Preschool; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D008297:Male