Incidental Diagnosis of a Double Aortic Arch during an Acute Myocardial Infarction

A 65-year-old previously asymptomatic woman with a history of tobacco use presented after experiencing an hour of chest pain and syncope. A 12-lead electrocardiogram revealed an inferior ST-elevation myocardial infarction. Coronary angiography revealed an acute thrombotic occlusion of the right coronary artery (Fig. 1); however, there was difficulty in maneuvering diagnostic catheters to the coronary ostia. Subsequent aortography revealed a double aortic arch (Fig. 2). After revascularization, 64-slice computed tomography (CT) of the aorta (Fig. 3) showed a dominant right aortic arch (Fig. 4A) to the right of the trachea, with separate ostia of the right subclavian and common carotid arteries. A more inferiorly located left aortic arch (Fig. 4B) connected the ascending and descending aorta at the left of the trachea, with separate ostia of the left subclavian and common carotid arteries. No vascular ring was seen. The aorta was also right sided (Fig. 4C). Fig. 1. Coronary angiogram, left anterior oblique view, shows an acute thrombotic occlusion (arrow) of the right coronary artery. Fig. 2. Aortogram, left anterior oblique view, shows evidence of a double aortic arch system. Fig. 3. This 64-slice cardiac computed tomogram is a 3-dimensional volume rendering (left anterior oblique view) that correlates with the aortographic view in Fig. 2. Fig. 4. 64-Slice cardiac computed tomograms (all axial views) at the levels of the A) right and B) left aortic arches and the C) aortic valve. In C, note the stent (arrow) in the right coronary artery at the level of the aortic valve. The descending aorta is ...