16 month old boy with wheezing.
â€¢ The patient has a double aortic arch with mild right-arch dominance in size (right arch 8 mm left arch 6 mm diameter).
â€¢ There is resulting mass-effect on the trachea where the trachea narrows to 3.5 mm.
â€¢ There is posterior mass-effect on the esophagus with resulting dilation of the more proximal esophagus. The distal esophagus is also dilated and courses slightly to the left of the aorta.
â€¢ The right carotid artery and right subclavian artery originate separately from the right arch while the left carotid artery and left subclavian artery have separate origins from the left arch.
â€¢ The descending aorta travels just to the right of midline and then midline more inferiorly.
Double aortic arch
The fundamental principle of surgical management of double aortic arch is division of the ring to relieve compression of the trachea and esophagus. In general, this is achieved by dividing the minor arch through an ipsilateral thoracotomy.
More on Treatment and Outcomes - http://pediatrics.aappublications.org/cgi/content/abstract/peds.2006-1097v1
Double aortic arch forms a complete vascular ring around the esophagus and trachea. The right dorsal aorta persists between its origin at the seventh intersegmental artery and its intersection with the left dorsal aorta. The right arch is typically larger than the left. Each arch gives off its own carotid and subclavian arteries. Typically, the descending aorta is midline instead of its normal left paraspinal locaion.
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