Persistent Right Aortic Arch (PRAA) in a 7-Week Old French Bulldog

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A 7-week old intact female French Bulldog was presented to the Cornell University Hospital for Animals (CUHA) Emergency Service on July 24th for further assessment and correction of a presumed PRAA vascular anomaly. The presenting complaints were ill-thrift and post-prandial regurgitation that began shortly after weaning. The dog was born via emergency cesarean section on June 17, 2017, had reduced weight gain relative to her litter mates, post-prandial regurgitation after transitioning from milk to food, and a computed tomography scan at the referring specialty practice that revealed a presumptive PRAA. She was unvaccinated and had not received antihelmentics. Physical examination was relatively unremarkable, aside from a reduced body condition score (2/9).

On July 25th, she was transferred to the CUHA Soft Tissue Surgery Service. Three-view thoracic radiographs revealed esophageal dilatation cranial to the base of the heart. Computed tomography showed multiple vascular malformations, including a right-sided aorta, and segmental esophageal enlarged cranial to the heart base. A vascular ring anomaly was diagnosed and attributed to a persistent right fourth aortic arch and a presumed left sixth aortic arch (ligamentum arteriosum): the ligamentum arteriosum was not observed during CT because the lumen was not patent and so does not contrast enhance. Surgery was successful in ligating the ligamentum arteriosum—thus freeing the esophagus from the vascular ring anomaly—and the esophageal stricture was bougienaged to facilitate feeding.

Post-prandial regurgitation continued following surgery, and a barium swallow study revealed that the esophageal stricture continued to prevent flow of ingesta through the esophagus into the stomach. Repeat esophageal bougienage was performed the following day and an esophageal tube was placed to facilitate feeding. The CUHA Nutrition Service was consulted for recommendations regarding feeding protocols, and she was discharged to the care of her owners on July 31st, 2017.

This case will discuss the embryological origins of persistent right aortic arch, as well as clinical presentation, surgical correction and post-surgical care in affected patients.

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Dog -- persistent right aortic arch -- vascular ring anomaly -- congenital -- post-prandial regurgitation


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