![]() ![]() This can be helpful in preoperative surgical planning, but it should be reserved for patients in whom vascular ring surgery is considered. CT scans can be performed when there is a concern for a vascular ring causing important symptoms. If the first branch of the aorta bifurcates to the left, then a right aortic arch is present. By echocardiography, the first branch of the aorta defines the sidedness of the aortic arch. An echocardiogram evaluation will demonstrate any associated intracardiac abnormalities and can demonstrate arch sidedness, including the anatomy of the arch. A barium swallow evaluation can demonstrate a posterior esophageal indentation from the aberrant left subclavian in patients with a vascular ring. This occurs from the aortic arch crossing over the right bronchus instead of the more common right-sided deviation from a left-sided aortic arch. Ī chest x-ray can demonstrate the trachea deviated to the left in the presence of a right aortic arch. This differentiation is very important as the expected symptomatology, and surgical treatment are different. Rarely, a double aortic arch with an atretic left segment can be misdiagnosed as a right aortic arch. An extremely rare form of a right aortic arch with isolation of the left subclavian from a ductal attachment to the left pulmonary artery can occur. After the closure of the ductus arteriosus connection to the left pulmonary artery, and due to a retroesophageal course of the left subclavian artery, a vascular ring circumscribing the esophagus, causing am esophageal stricture. ![]() If an aberrant left subclavian is present (type 2 aortic arch), the ductus arteriosus originates from this subclavian artery, which leads to an outpouching of the aorta (diverticulum of Kommerell). In type 2 right-sided aortic arch, the first branch off the aorta is the left common carotid artery, followed by the left common carotid artery, right subclavian artery, and finally the left subclavian artery. The ductus arteriosus in this scenario originates off the underside of the aortic arch or from the left innominate artery, which predisposes patients to left pulmonary artery stenosis or even isolation. This branching pattern is similar to the normal anatomical branching seen in the general population, however, in a mirror image. This includes a mirror type right aortic arch, defined by the first branch originating from the aorta being the left innominate artery, the second being the right common carotid artery, and the third being the right subclavian artery. Depending on the formation of the other branches of the aortic arch, various forms of the right aortic arch can develop. Embryologically, this develops when the right dorsal aorta persists and the left dorsal aorta regresses. A right aortic arch occurs when the aortic arch traverses over the right bronchus instead of the left bronchus (which defines a left aortic arch). ![]()
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