Difference between revisions of "Vascular Ring Anomalies"

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Conditions included: '''''Persistent Right Aortic Arch (PRAA) — Double Aortic Arch — Anomalous Subclavian Arteries'''''
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[[Image:dog-logo.png|right|40px]]
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[[Image:dextra-aorta.jpg|right|thumb|125px|<small><center>'''Dextra-aorta'''. Courtesy of A. Jefferies</center></small>]]
  
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== Introduction==
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*Seen most frequently in young animals right after weaning  
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[[Image:Praa.gif|thumb|right|200px|<center>Post-mortem specimen of an animal with a persistent right aortic arch <br><small> Alun Williams 2009 (RVC))<center></small>]]
 
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This congenital condition is most commonly found in dogs after weaning, but is very rare in cats.
 
  
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'''Persistent Right Aortic Arch''' is the most common vascular ring anomaly, increased incidence in German Shepherd Dogs, Irish setters and Great Danes. Vascular ring forms between the ductus arteriosus/ligamentum arteriosum and the persistent right aorta. [[Megaoesophagus]] is seen cranial to the constriction. Other causes include a '''double aortic arch''' and '''anomalous subclavian arteries'''. These arise from the aortic arch rather than the brachiocephalic artery.
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*Common in dogs
  
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During normal embryonic development there are five pairs of aortic arch arteries (1-6, 5 is absent) that undergo developmental changes necessary to form the major arteries of the head, neck, and upper thorax.
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*Very rare in cats
  
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Malformations of the aortic arch arteries can cause several vascular ring anomalies, but the most commonly seen anomaly is persistent right aortic arch (PRAA). With PRAA, the oesophagus and trachea are most often encircled by the left ligamentum arteriosum as they pass over the heart base causing chronic oesophageal and tracheal compression.
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===Signalment===
  
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When a young animal with PRAA is weaned onto solid food, the oesophageal and tracheal compression causes food stasis above the narrowed esophageal foramen leading to megaesophagus. Continued stress on the oesophagus in this manner can cause permanent damage. Additionally, [[Aspiration Pneumonia|aspiration pneumonia]] and the resulting respiratory distress is a complication of postprandial regurgitation.
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*Genetics & Predisposed Breeds: Large Breeds make up the majority of cases (German Shepherd, Great Dane)
  
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== Clinical Signs ==
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===Description===
  
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Clinical signs are usually due to constriction of the oesophagus, such as '''regurgitation of food''', usually noticed at weaning and aspiration pneumonia. This may be seen as '''coughing'''.  
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*During normal embryonic development there are five pairs of aortic arch arteries (1-6, 5 is absent) that undergo developmental changes necessary to form the major arteries of the head, neck, and upper thorax.  
  
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The animal may present as '[[vomiting]]' but thorough history and physical exam should distinguish this from regurgitation.  
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*Malformations of the aortic arch arteries can cause several vascular ring anomalies, but the most commonly seen anomaly is persistent right aortic arch (PRAA). With PRAA, the esophagus and trachea are most often encircled by the left ligamentum arteriosum as they pass over the heart base causing chronic esophageal and tracheal compression.  
  
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Respiratory distress may also be seen. '''Stunted growth''', thin and malnourished with an increased appetite may also be a clinical sign.  
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*When a young animal with PRAA is weaned onto solid food, the esophageal and tracheal compression causes food stasis above the narrowed esophageal foramen leading to megaesophagus. Continued stress on the esophagus in this manner can cause permanent damage. Additionally, aspiration pneumonia and the resulting respiratory distress is a complication of postprandial regurgitation.  
  
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== Diagnosis ==
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===Diagnosis===
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====History & Clinical Signs====
  
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History and clinical signs plus age and breed may be indicative of the disease.
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-Regurgitation (Postprandial=after meals)
  
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On physical exam, there will be no cardiac murmurs unless a [[Patent Ductus Arteriosus]] (PDA) is also present. A palpable dilated cervical oesophagus may be detected.
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-Coughing
  
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'''Radiographs''' should be taken for further diagnostics and will show a ventral deviation of the trachea and dilation of the oesophagus. A '''barium swallow''' will provide definitive diagnosis of this condition.
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-Respiratory distress
  
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== Treatment  ==
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-Small size
  
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'''Surgical resection''' should be performed as soon as possible. '''Aspiration pneumonia''' should be treated first if present, and dietary management should be put in place to minimise regurgitation: this involves feeding a liquid or gruel diet in small amounts from an elevated position.
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-Underweight (Malnourished)
  
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Surgical treatment involves '''transecting the ligamentum arteriosum''' via an intercostal thoracotomy. The ligament should be ligated before transection in case a [[Patent Ductus Arteriosus|patent ductus arteriosus]] is also present.
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-Increased appetite
  
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A gastric tube is passed down the oesophagus to ensure no constrictions remain.
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====Physical Exam====
  
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== Prognosis ==
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-No cardiac murmurs unless PDA is also present
  
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'''Good with early surgical treatment''', but less favourable if there is extensive oesophageal damage.
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-Palpable dilated cervical esophagus
  
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Post-operative care is aimed at preventing aspiration pneumonia, and mainly involves '''dietary management'''. Normal food can be gradually reintroduced after 4 weeks.
 
  
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If surgery cannot be performed, for whatever reason, then thoughts into the quality of life of the animal without surgery must be taken into consideration.
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====Radiographic Findings====
  
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{{Learning
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-Megaesophagus in the thoracic inlet (+/- barium series)
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|Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis00916.asp, Vascular ring anomalies]
 
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|flashcards = [[Small Animal Soft Tissue Surgery Q&A 19]]
 
  
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[[Cardiovascular Developmental Pathology Flashcards]]
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====Echocardiographic Findings====
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}}
 
  
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== References ==
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Not used to diagnose a PRAA
  
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Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat '''Volume 2 (Fifth Edition)'' W.B. Saunders Company''
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====Electrocardiographic (ECG)====
  
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Ettinger, S.J, Feldman, E.C. (2005)''' Textbook of Veterinary Internal Medicine '''(6th edition, volume 2) ''W.B. Saunders Company''
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Not used to diagnose a PRAA
  
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Fossum, T. W. et. al. (2007) '''Small Animal Surgery''' (Third Edition) ''Mosby Elsevier ''
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===Treatment===
  
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Merck & Co (2008) '''The Merck Veterinary Manual '''(Eighth Edition) ''Merial''
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-Surgical sectioning of the vascular ring anomaly to relieve constriction of the esophagus and trachea
  
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Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine '''(Fourth Edition) ''Mosby Elsevier''
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-Management of esophageal damage: frequent feeding of small semi-solid/liquid meals from an elevated position
  
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===Prognosis===
  
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{{review}}
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-Good with surgery
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{{OpenPages}}
 
  
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[[Category:Cardiovascular_System_-_Developmental_Pathology]] [[Category:Oesophagus_-_Pathology]] [[Category:Expert_Review - Small Animal]] [[Category:Cardiac_Diseases_-_Cat]] [[Category:Oesophageal_Diseases_-_Cat]] [[Category:Cardiac_Diseases_-_Dog]] [[Category:Oesophageal_Diseases_-_Dog]]
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-Less favourable if there is extensive esophageal damage
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[[Category:Cardiology Section]]
 

Revision as of 11:05, 6 October 2008

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Dextra-aorta. Courtesy of A. Jefferies
  • Seen most frequently in young animals right after weaning
  • Common in dogs
  • Very rare in cats

Signalment

  • Genetics & Predisposed Breeds: Large Breeds make up the majority of cases (German Shepherd, Great Dane)

Description

  • During normal embryonic development there are five pairs of aortic arch arteries (1-6, 5 is absent) that undergo developmental changes necessary to form the major arteries of the head, neck, and upper thorax.
  • Malformations of the aortic arch arteries can cause several vascular ring anomalies, but the most commonly seen anomaly is persistent right aortic arch (PRAA). With PRAA, the esophagus and trachea are most often encircled by the left ligamentum arteriosum as they pass over the heart base causing chronic esophageal and tracheal compression.
  • When a young animal with PRAA is weaned onto solid food, the esophageal and tracheal compression causes food stasis above the narrowed esophageal foramen leading to megaesophagus. Continued stress on the esophagus in this manner can cause permanent damage. Additionally, aspiration pneumonia and the resulting respiratory distress is a complication of postprandial regurgitation.

Diagnosis

History & Clinical Signs

-Regurgitation (Postprandial=after meals)

-Coughing

-Respiratory distress

-Small size

-Underweight (Malnourished)

-Increased appetite

Physical Exam

-No cardiac murmurs unless PDA is also present

-Palpable dilated cervical esophagus


Radiographic Findings

-Megaesophagus in the thoracic inlet (+/- barium series)

Echocardiographic Findings

Not used to diagnose a PRAA

Electrocardiographic (ECG)

Not used to diagnose a PRAA

Treatment

-Surgical sectioning of the vascular ring anomaly to relieve constriction of the esophagus and trachea

-Management of esophageal damage: frequent feeding of small semi-solid/liquid meals from an elevated position

Prognosis

-Good with surgery

-Less favourable if there is extensive esophageal damage

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