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right aortic arch

Wednesday 5 March 2008

Right aortic arch: may be associated with vascular rings and cyanotic heart disease and may complicate the repair of tracheoesophageal .
Right Aortic Arch
At least five different types
Only two of importance
Mirror Image Type — Type I
Aberrant left subclavian — Type II

Recognized by leftward displacement of barium-filled esophagus
Of air-filled trachea
Aortic knob is absent from left side
Aorta descends on right
Para-aortic stripe returns to left side of spine just above diaphragm
Mirror-image type almost always has associated CHD
Usually Tetralogy of Fallot
Aberrant Left Subclavian type rarely has associated CHD
Most common variety of right arch

Type 1—Mirror Image Type
Secondary to interruption of left arch just distal to ductus arteriosis
Associated with congenital heart disease 98% of time
X-ray Findings
No posterior impression on trachea or barium-filled esophagus
Heart is usually abnormal in size or shape
Aorta descends on right

Type ll—Aberrant Left Subclavian
Secondary to interruption of left aortic arch between LCC and LSC arteries
Associated with cardiac defects 5-10% of the time
Tetralogy of Fallot most often (71%)
ASD or VSD next most often (21%)
Coarctation of aorta rarely (7%)
Anomalous left subclavian artery (retroesophageal and retrotracheal)
Aorta descends on right


- DiGeorge syndrome
- situs anomalies