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Abstract：
BACKGROUND The VACTEREL association is an acronym that includes vertebral malformations (V), anal atresia (A), cardiac defects (C), tracheoesophageal fistula (TE), renal defects (R), and limb malformations (L). The aortic arch is the section between the ascending aorta and the descending aorta, where some variants have been described, such as the right aortic arch and bovine aortic arch, among others. A rare presentation in the Natsis classification is the \"type X\" where a bovine aortic arch and anomalous origin of the left vertebral artery are present. Several structural cardiac malformations have been described in the VACTEREL association. Still, there is no bovine arch or an anomalous left vertebral artery. CASE REPORT Our patient was a 3-year-old boy with a diagnosis of VACTEREL association (type III esophageal atresia, congenital hip dislocation, scoliosis, bilateral clubfoot, and grade IV biliary ureteral reflux). Echocardiographic findings showed changes in the aortic arch, and angiotomography and magnetic resonance angiography showed a bovine aortic arch and an anomalous left vertebral artery. At the time of diagnosis, there were no clinical manifestations or complications due to the anomalous origin of the left vertebral artery. CONCLUSIONS This is the first description of a bovine type X arch according to the Natsis classification in a VACTEREL association. In general, knowledge of the anatomical variants of the aortic arch and the origin and course of the vertebral arteries is of great clinical and interventional importance, mainly because of the risk of cerebral ischemia.
摘要：
背景技术VACTEREL协会是包括椎骨畸形(V)的首字母缩写词,肛门闭锁(A),心脏缺陷（C），气管食管瘘（TE），肾缺陷(R),和肢体畸形（L）。主动脉弓是升主动脉和降主动脉之间的部分，其中描述了一些变体，如右主动脉弓和牛主动脉弓，在其他人中。Natsis分类中罕见的表现是“X型”，其中存在牛主动脉弓和左椎动脉异常起源。VACTEREL协会已经描述了几种结构性心脏畸形。尽管如此，没有牛弓或左侧椎动脉异常。病例报告我们的患者是一名3岁男孩，诊断为VACTEREL关联（III型食管闭锁，先天性髋关节脱位,脊柱侧弯,双侧马蹄内翻足,和IV级胆道输尿管反流）。超声心动图显示主动脉弓改变，血管造影和磁共振血管造影显示牛主动脉弓和左侧椎动脉异常。在诊断的时候,未出现因左侧椎动脉起源异常引起的临床表现或并发症.结论这是VACTEREL协会中根据Natsis分类的牛X型弓的第一个描述。总的来说,了解主动脉弓的解剖变异以及椎动脉的起源和过程具有重要的临床和介入重要性，主要是因为脑缺血的风险。
