Nasir Afzal.
Fatal double aortic arch anomaly and maternal cocaine abuse.
J Coll Physicians Surg Pak Jan ;13(3):166-7.

We report a case of 2 months old female (born to a cocaine abuser mother) having respiratory dysfunction attributed to pneumonia. Autopsy, following a sudden, unexpected death, revealed a double aortic arch which was compressing the trachea and the esophagus. Health care professionals should conduct a detailed cardiac assessment on all cocaine-exposed infants at the time of birth and during infancy. Double aortic arch should be considered as a possible complication of intrauterine cocaine exposure and may present as sudden death.

Case Reports: A 2 months old female infant presented with respiratory dysfunction. Pneumonia was suspected. Previously no medical consultation was sought for the ailing baby. The mother was a cocaine abuser and the baby had withdrawal symptoms at the time of birth. There was no known medical or family history. The mother found her baby unresponsive in her bed. On autopsy examination, the body size (20 inch length), weight (12 pounds) and combined heart and lung weight were within normal limits. Epicardial fat and atrial situs were normal and there was no chamber dilatation. Mitral, tricuspid, aortic and pulmonary valves were normal and there was no evidence of myocardial hypertrophy or fibrosis. The aortic examination showed a double aortic arch anomaly of right persistent dominant arch type. The aorta was encircling the trachea and esophagus. The right common carotid, right vertebral and right subclavian artery arose from right arch and left carotid and left subclavian artery originated from the left aortic arch. Only left ductus was present, which was not patent, and the descending aorta was in neutral position. No other congenital or acquired abnormality of the cardiovascular or respiratory systems was seen. Microscopic examination of the myocardium was unremarkable. Sections from lungs were edematous and congested. There was no evidence of bronchitis or pneumonitis.

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