case_images: PMC11045998_01
case_images: A D-TGA with a DAA. Image (A-D) The red blood vessel is the aorta with a double aortic arch; the blue one is the pulmonary artery. (A) A view from above; (B) a view from below; (C) a view from the right side; and (D) a view from the left side. (E-G) A CT scan 3D rendering of the double aortic arch in the transposition of the great arteries and the relationship with the trachea. (E) An anterior view; (F) a view from the right side; and (G) a posteroleft view. Ant, anterior; Post, posterior; R, right; L, left; Ao, aorta; LPA, left pulmonary artery; LPDA, left patent ductus arteriosus; Tr, trachea.
case_images: fcvm-11-1351530-g001.jpg
case_images: PMC11045998_01_fcvm-11-1351530-g001.jpg
case_images: F1
case_images: Two symmetrical aortic arches surrounded the trachea, each giving rise to separate arteries, respectively: the left carotid and left subclavian arteries, and the right carotid and right subclavian arteries (Figures 1, 2). A CT chest x-ray with angiography revealed severe tracheal narrowing with subocclusion (>85%) and tracheobronchomalacia caused by a vascular ring (VR), secondary to compression (Figure 1).
case_images: Images taken from a fetal transthoracic echocardiogram. (A) A cross-sectional view at the level of the aortic arch, with a color Doppler, where it is possible to observe the complete vascular ring surrounding the trachea, consisting of a double aortic arch. (B) A cross-sectional view at the level of the epiaortic vessels, with a color Doppler, showing the four epiaortic vessels originating separately (two on the right and two on the left). Ant, anterior; LAA, left aortic arch; LCA, Left carotid artery; LSA, left subclavian artery; Post, posterior; RCA, right carotid artery; RSA, right subclavian artery; T, trachea.
case_images: fcvm-11-1351530-g002.jpg
case_images: PMC11045998_01_fcvm-11-1351530-g002.jpg
case_images: F2
case_images: Two symmetrical aortic arches surrounded the trachea, each giving rise to separate arteries, respectively: the left carotid and left subclavian arteries, and the right carotid and right subclavian arteries (Figures 1, 2).
case_images: Images taken from a fetal transthoracic echocardiogram. (A) A long-axis view, with a color Doppler, where it is possible to observe the D-transposition with the anterior aorta and posterior pulmonary artery; the ventricular septal defect, with a dysplastic pulmonary valve. (B) An off-axis view at the level of the aortic arch, with a color Doppler, showing the anterior aorta with its complete vascular ring surrounding the trachea, consisting of a double aortic arch, and the posterior pulmonary artery. Ant, anterior; LAA, left aortic arch; LV, left ventricle; Post, posterior; RV, right ventricle; T, trachea.
case_images: fcvm-11-1351530-g003.jpg
case_images: PMC11045998_01_fcvm-11-1351530-g003.jpg
case_images: F3
case_images: Subpulmonary VSD and pulmonary valve (PV) dysplasia with a right outflow tract obstruction were also noted (Figure 3).
case_images: (A,B) A preoperative transthoracic echocardiogram: a parasternal long-axis view and five-chamber view with and without a color Doppler, highlighting the posterior deviation of the infundibular septum causing subvalvular and valvar pulmonary obstruction and the restrictive interventricular septal defect. Images (C,D), A postoperative transthoracic echocardiogram: a parasternal long-axis view without and with a color Doppler, showing an excellent surgical outcome after an arterial switch operation, closure of the interventricular defect, and resection of the infundibular septum. AO, aorta; Inf Sept, infundibular septum; LV, left ventricle; PA, pulmonary artery.
case_images: fcvm-11-1351530-g004.jpg
case_images: PMC11045998_01_fcvm-11-1351530-g004.jpg
case_images: F4
case_images: After addressing the respiratory complications, the patient, who weighed 3.5 kg, underwent an arterial switch operation (ASO), VSD closure, and resection of a part of the infundibular septum, accepting the risk of potential neoaortic obstruction (Figure 4).