Feyza Aysenur Pac

Wall motion velocities of ascending aorta measured by tissue Doppler imaging in obese children

Background:  Obesity is associated with the development of early cardiovascular abnormalities such as atherosclerotic lesions. Arterial stiffness may be an indicator of early vascular changes signaling the development of vascular disease. The objective of the current study was to screen aortic elastic properties with tissue Doppler imaging in obese children.

Left Aortic Arch and Right Descending Aorta With Kommerell’s Diverticulum

A left-sided aortic arch with a right-sided descending thoracic aorta is a rare anomaly first reported by Paul [4] in 1948. To our knowledge, only 21 cases have been reported in the literature [1, 3, 5]. This aortic anomaly results from regression of the right aortic arch between the right common carotid artery and the right subclavian artery, with persistence of the distal end of the primitive right dorsal aorta [4]. The patients with this aortic anomaly present with swallowing or respiratory difficulties early in life due to compression of the esophagus, trachea, or right mainstream bronchus due to a commonly existing right-sided ligamentum arteriosum or patent ductus arteriosus, which forms a vascular ring [1, 2]. Diverticulum-like outpouching of the aorta has been described in some infant cases with an aberrant right subclavian artery [2]. However, the association of the left aortic arch and the right descending aorta with Kommerell’s diverticulum is an extremely rare entity, and to date, only one case has been reported in the literature [5]. We present the aortographic and multidetector computed tomographic (MDCT) angiographic findings of another case with such an anomaly. The patient was a 12-year-old boy with a history of surgery for atrial septal defect and complete vascular ring. He had undergone surgery due to a secundum-type atrial septal defect 6 years previously. A complete vascular ring due to a left aortic arch, aberrant right subclavian artery, and left ligamentum arteriosum, described during surgery, was released by division of the ligamentum. The boy had no complaints, and his physical examination results were normal. Echocardiography showed the right common carotid artery to be the first branch arising from the arcus, indicating a possible left aortic arch. In contrast, the descending aorta was on the right side, and further, a diverticulum involved the distal portion of the arch at the right side. We considered that this might be a variant of Kommerell’s diverticulum. However, we could not exactly define the side of the aortic arch due to the order of the brachiocephalic arteries and the rightsided descending aorta. Therefore, we performed angiography, which showed that the first branch of the aortic arch was the right common carotid artery, followed by the left common carotid and the left subclavian arteries. In the upper thorax, the aorta turned abruptly to the patient’s right, whereas the thoracic aorta continued as a right-sided descending thoracic aorta. The last (fourth) aortic arch vessel was an aberrant right subclavian artery arising from Kommerell’s diverticulum at the descending thoracic–aortic junction in the right chest (Fig. 1). We diagnosed the pathology as left aortic arch and right descending aorta coexisting with Kommerell’s diverticulum. When MDCT angiography was performed on the volume-rendered three-dimensional (3D) image, the transverse diameter of Kommerell’s diverticulum was found to be 1.9 cm (Fig. 2). Although the patient had no complaints, we performed a barium esophagram, which showed compression of the esophagus by Kommerell’s diverticulum and the retroesophageal portion of the aortic arch (Fig. 3). We decided to perform a clinical and echocardiographic follow-up assessment every 6 months and a computed tomography scan annually due to potential aneurysmal dilation of Kommerell’s diverticulum. F. A. Pac (&) S. Okten _ I. Ece Department of Pediatric Cardiology, Turkiye Yuksek Ihtisas Education and Research Hospital, Kizilay S, No: 4, 06100 Sihhiye, Ankara, Turkey e-mail: aysepac@gmail.com