ISSN 2398-2969      

Vascular ring anomalies

icanis

Synonym(s): Persistent right aortic arch, PRAA, VRA


Introduction

  • Cause: developmental abnormality of vessels.
  • Esophageal dilation cranial to base of heart in puppies and kittens.
  • Most common (95%) - persistent right aortic arch (PRAA).
  • Less common - double aortic arches, anomalous subclavian arteries.
  • Signs: regurgitation on weaning, voracious appetite, aspiration pneumonia, smaller than litter mates.
  • Diagnosis: signs, radiography, endoscopy.
  • Treatment: aggressive supportive therapy and surgical correction of anomaly.
  • Prognosis: depends on degree of megaesophagus.
  • Usually no cardiovascular signs.

Pathogenesis

Etiology

  • Congenital: persistent right aortic arch (stricture caused by ligamentum or ductus arteriosus, pulmonary artery and dextraposed aorta), double aortic arches, anomalous subclavian arteries.

Predisposing factors

General
  • Breed, ?inherited congenital defect.

Specific

  • Clinical signs exacerbated by feeding solid or semi-solid foods.

Pathophysiology

  • Aberrant embryological development of great vessels at the heart base → esophagus encircled at the heart base by a right aortic arch, a ligamentum arteriosum (or patent ductus arteriosus) and the pulmonary trunk → accumulating food boluses proximal to vascular ring → esophageal dilation and eventual loss of function (megaesophagus) → typical signs of megaesophagus Megaesophagus.
  • Frequent regurgitation attempts may cause gastric acid reflux and esophagitis distal to the vascular ring.
  • Fibrosis may occur affecting adventitia around esophagus at site of vascular ring → esophageal stenosis.
  • Aspiration pneumonia is a common complication.

Timecourse

  • From weaning until successful correction.
  • Life-long management may be necessary if megaesophagus occurs before surgery Megaesophagus.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Du Plessis C J, Keller N & Joubert K E (2006) Symmetrical double aortic arch in a beagle puppy. JSAP 47 (1), 31-34 PubMed.
  • House A K, Summerfield N J, German A J et al (2005) Unusual vascular ring anomaly associated with a persistent right aortic arch in two dogs. JSAP 46 (12), 585-590 PubMed.
  • Vianna M L, Krahwinkel D J Jr (2004) Double aortic arch in a dog. JAVMA 225 (8), 1222-1224, 1196-1197 PubMed.
  • Buchanan J W (2003) Tracheal signs and associated vascular anomalies in dogs with persistent right aortic arch. JVIM 18 (4), 510-514 PubMed.
  • Findji L & Degueurce C (1999) Symmetrical double aortic arch in a dog. Vet Rec 145 (16), 465-466 PubMed.
  • VanGundy T (1989) Vascular ring anomalies. Comp Cont Ed Pract Vet 11 (1), 36-48 AGRIS FAO.
  • Fingeroth J M & Fossum T W (1987) Late onset regurgitation associated with persistent right aortic arch in two dogs. JAVMA 191 (8), 981-3 VetMedResource.
  • Helphrey M L (1979) Vascular ring anomalies in the dog. Vet Clin North Am Small Anim Prac (2), 207-218 PubMed.

Other sources of information

  • Fingeroth J M (1993)Surgical diseases of the esophagus. Vascular ring anomalies and surgical techniques for oesophageal disease. Correction of vascular ring anomalies.In: Slatter, D (ed)Textbook of Small Animal Surgery. 2nd edition. Philadelphia: W B Saunders. pp 538-544, 554-557.
  • Noden D M & DeLahunta A (1985)Cardiovascular system I. Blood and arteries.In:The Embryology of Domestic Animals. Developmental Mechanisms and Malformations.Baltimore: Williams & Wilkins. pp 211-230.

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