Management of double aortic arch in children

Double aortic arch (DAA) is a rare congenital malformation. Strategies for diagnosis and treatment are different. Thoracoscopic treatment of DAA is limited to case reports or little case series. We report a description of our diagnostic and therapeutic approach and evaluate outcomes.
We reviewed charts of infants with double aortic arch who were hospitalized in our department from 2008 to 2014. Age at symptom onset, clinical presentation, diagnostic modality, operative details and post operative outcomes were retrieved.
We identified 7 patients presenting at a median age of 11,8 months (range: 2months-27months) and median weight of 10kg. Respiratory symptoms were present in all cases. Difficulties in feedings were present in 3 cases. Chest radiography, oesophagogram and Computed Tomography (CT) with three-dimentional (3D) reconstructions were performed for all patients. One patient have had laryngo tracheoscopy and 3 patients echocardiography. The dominant branch was the right one in all cases. Associated cardiac anomaly was found in 1case. Operative approach was thoracotomy in 3 cases and thoracoscopic video assisted surgery (VATS) in 4 cases. Median operative time was 132min. Only one patient required conversion. Median hospital stay was 4,1days.
Double artic arch is a rare malformation which can cause persistent non specific respiratory symptoms in infants. The use of 3D-CT scan reconstruction that facilitate diagnosis and the operative approach. Thoracoscopy and thoracotomy are effective procedures even for patients with low weight. The operative time seems similar for both. Thoracoscopy offers less post operative analgesia, shorter hospital stay and good cosmetic results.