Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System

Vascular Rings around Trachea and Esophagus.

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed

A: Right-sided aortic arch and upper portion of the descending aorta, and left-sided ductus arteriosus in which the ductus arteriosis passed behind the esophagus to insert into an aortic diverticulum.
B: Right-sided aortic arch and upper portion of the descending aorta, and left-sided ductus arteriosus in which the ductus arteriosus inserted into a left subclavian artery which arose as the fourth branch from the aortic arch.
C: Left-sided descending aorta and left-sided ductus arteriosus.
D: Left-sided descending aorta and right-sided ductus arteriosus.
E. Right-sided upper portion of the descending aorta and right-sided ductus arteriosus.
F. Right-sided upper portion of the descending aorta and left-sided ductus arteriosus.

Kirklin, Clagett, and Edwards have provided the following classificiation of anomalies of aortic arch and a detailed discussion of these anomalies is givien by Edwards, J.E. Anomalies of the derivatives of the aortic arch system. Med. Clin. North Am. 32: 925-949, 1948.

Classification of Anomalies of Aortic Arch

I. Left-sided descending aorta.

A. Functioning double aortic arch.

1. Arches of approximately equal size.

2. One arch narrowed (usually but not always the anterior of left one)

B. Double aortic arch with partial atresia of one arch.
C. Right-sided aortic arch with retroesophageal segment and left-sided descending aorta.

1. Left subclavian artery originating from left-sided aortic diverticulum.

2. Left subclavian artery originating from left innominate artery

D. Left-sided aortic arch.

1. Right subclavian artery arising from the distal portion of the aortic arch from the descending aorta and passing to the right usually behind the esophagus.

2. Normal arch and normal branches.

E. Right-sided ductus arteriosus arising from right pulmonary artery. All possibilities occurring under A could occur here.

II. Right-sided upper portion of the descending aorta.

A. Right-sided ductus arteriosus arising from right pulmonary artery.

1. Finctioning double aortic arch.

a. Arches of approximately equal size

b. One arch narrowed.

2. Double aortic arch with partial atresia of one arch.
3. Left-sided aortic arch with retroesophageal segment and right-sided upper portion of the sescending aorta.

a. Right sublcavian artery originating from innominate artery on right side.

4. Right-sided aortic arch.

a. Left subclavian artery arising from the distal portion of the aortic arch of from the descending aorta and passing to the left, usually behind the esophagus.

b. Left subclavian artery originating from innominate artery on left side (mirror image of usual attern).

B. Left-sided ductus arteriosus arising from left pulmonary artery. All possibilites occuring under A could occur here.

Redrawn from Kirklin, J.W. and O.T. Clagett. Vascular "rings" producing respiratory obstruction in infants. Proc. Staff Meeting Mayo Clin. 25:360-367, 1950.

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