- “C” - Double aortic arch
- Rare anomaly caused by persistence (to varying degree) of the fetal double aortic arch system.
- The ascending aorta divides into two arches that pass to either side of the esophagus and trachea and reunite to form the descending aorta.
- Form of complete vascular ring, resulting in noncardiac morbidity, but rarely associated with intracardiac defects.
- The descending aorta is usually on the left side.
- Most commonly, one arch is dominant, whereas the other may be of small caliber or represented by a fibrous band - “A” - Right AA with mirror image branching
The mirror-image type of the right aortic arch (left brachiocephalic trunk, right common carotid and subclavian arteries) is almost always associated with congenital heart disease, especially the cyanotic type. - “B” - Right AA with aberrant left subclavian artery
- Right aortic arch is an uncommon anatomical anomaly that occurs in <0.1% of the population.
- The most common type is the right aortic arch with an aberrant left subclavian artery
- The vessels originate in the following order: left common carotid, right common carotid, right subclavian, and left subclavian artery.
- Symptoms may arise from vascular ring formation as congenital heart disease is rare in this variant. - “D” - Left AA with aberrant right subclavian artery
- The right subclavian artery is the last branch of the aortic arch in l% of individuals.
- It courses to the right behind the esophagus in 80% of these cases, between the esophagus
and trachea in 15%, and anterior to the trachea or mainstem bronchus in 5%.
- A retroesophageal course may be the cause of so-called dysphagia lusoria.
- Another variant - aberrant right brachiocephalic artery is rare - Vascular Ring Hierarchy
- If abnormal combination of derivatives of the aortic arch system results in encirclement of
the trachea and the esophagus it is often referred to as “vascular ring”.
- International Congeital Heart Surgery Nomenclature And Database Committee
Classification:
- Double aortic arch
- Right arch dominant
- Left arch dominant
- Balanced arches
- Right aortic arch–left ligamentum
- Mirror-image branching
- Retroesophageal left subclavian artery
- Circumflex aorta
- Pulmonary artery sling - Normal Anatomy
- Predominant human anatomy is a left aortic arch with three great vessels; first, the
brachiocephalic trunk, then the left common carotid artery and finally the subclavian artery.
This pattern occurs in 65-80% of the cases.
- A common brachiocephalic trunk, so-called “bovine trunk”, in which both common carotid
arteries and the right subclavian artery arise from a single trunk off the arch, occurs in 10 to
22% of individuals and accounts for more than two thirds of all arch vessel anomalies. - Double Aortic Arch: Facts
- Most common symptomatic vascular aortic arch
- The right arch is larger , posterior, ad more cephalad than the left arch in two thirds of patients and the descending aorta is usually contralateral to the dominant arch
- Trachea compression is common
- Descending aortic diverticulum (Kommerell) is not uncommon - Aberrant left subclavian artery: facts
- Left subclavian arise as last arch vessel and crosses right to left (patient has right sided arch) and posterior to the esophagus
- Bulblike dilatation of abberrant subclavian can occur and is called diverticulum of Kommerell
- When large the diverticulum of Kommerell can cause symptoms of dysphagia - Aortic Arch Anomalies
- Aberrant left subclavian artery
- Mirror image branching
- Right aortic arch with left descending aorta
- Right aortic arch with aberrant branchiocephalic artery
- Right aortic arch with isolated left subclavian artery
- Double aortic arch
- Cervical aortic arch - Anomalies of the Aortic Arch: facts
- Frequency ranges from 0.5% to 3%
- Most patients asymptomatic though others may have dysphagia, dyspnea, hypertension or congestive heart failure
- Right aortic arch occurs in 0.1% of adults
- There are 6 paired arteries arising from the aortic sac during embryogenesis with the fourth left arch forming the aortic arch - CT of the Bronchial Arteries
- The bronchial arteries arise directly from the descending aorta and supply blood to the airways, esophagus and lymph nodes
- The left bronchial arteries arise from the anterior surface of the aorta or the concavity of the arch
- The right bronchial arteries arise from the posterolateral aspect of the thoracic aorta - Massive Hemoptysis: Common Etiologies
- Pulmonary TB
- Bronchogenic carcinoma
- Cystic fibrosis
- Aspergillosis Lung abscess
- Pneumonia
- Pulmonary artery aneurysm
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