Balanced double aortic arch demonstrated by multimodality image and 7-year follow-up in a symptomatic elderly patient: A case report

Double aortic arch is a very rare congenital heart disease. Double aortic arch forms a vascular ring, compressing the esophagus and trachea, causing symptoms mainly in infants and young children, and symptoms rarely appear after adulthood. The management of double aortic arch depends on the severity of the symptoms, but since aging exacerbates atherosclerosis and complicates surgery, treatment in adults has many considerations. A 55-year-old woman admitted for chest discomfort, mild dyspnea and mild dysphagia. On a simple chest X-ray, dilated upper mediastinum and bilateral aortic knobs were noted. Transthoracic echocardiography revealed 2 aortic arches on suprasternal view. Contrast-enhanced computed tomography and 3-dimensional computed tomography demonstrated a balanced double aortic arch which formed a complete vascular ring and compressed the esophagus. Barium esophagogram showed marked luminal narrowing at the aortic arch level, probably due to indentation of the double aortic arch. She had several risk factors regarding progression of aortic atherosclerosis include old age, hypertension and dyslipidemia that make more severe compression of esophagus and trachea, but the symptoms were not severe, so we decided to observation while controlling the risk factors. For the next 7 years, she stayed without worsening of symptoms.