Andersons pediatric cardiology 1258
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Classification
Anomaliescanbeclassifiedintofourgroups,dependingonthepositionofthe
aorticarchrelativetothetracheaandthepatternofbranchingofthe
brachiocephalicarteries:
■Leftaorticarchwithaberrantrightsubclavianor
brachiocephalicartery
■Rightaorticarchwithaberrantleftsubclavianor
brachiocephalicartery
■Rightaorticarchwithmirror-imagebranching
■Doubleaorticarch
Mostofthemajoranomaliesproduceacompleteorpartialvascularring
aroundthetracheaandesophagus.Theonlyexceptionistheclassicformofright
aorticarchwithmirror-imagebranching.Aberrantoriginofasubclavianor
brachiocephalicbranchoftheaorticarchproducesencirclementofthetrachea
andesophagusbecausetheanomalousarterytakesaretroesophagealcourse.The
arterialduct,regardlessofwhetheritispatentorligamentous,mayalso
contributetoencirclementofthetracheaandesophagus.Occasionallythedistal
aorticarchitselfhasaretroesophagealcoursethatcausesesophagealand
trachealcompression.Thereforetheassessmentanddescriptionoftheanomalies
shouldincludedescriptionof:
■Thepositionoftheaorticarchrelativetothe
trachea
■Thelocationofthemostproximalpartofthe
descendingaortainrelationtothespine
■Thepresenceorabsenceofanaberrantbranch
■Theoriginandinsertionofthepatentor
ligamentousarterialductor,rarely,ducts
Theanomaliesproducingacompleteorpartialvascularringaroundthe
tracheaandesophagusare:
■Aorticarchanomaliesformingacompletevascular
ring:
■Doubleaorticarch
■Rightaorticarchwithaberrantleftsubclavian
orbrachiocephalicarteryandleft-sided
arterialduct
■Leftaorticarchwithaberrantrightsubclavian
orbrachiocephalicarteryandright-sided
arterialduct
■Rightaorticarchwithmirror-image
branchingandretroesophagealleftarterial
ductbetweenright-sideddescendingaorta
andleftpulmonaryartery
■Circumflexretroesophagealaorticarch
■Aorticarchanomaliesformingapartialvascular
ring:
■Leftaorticarchwithaberrantrightsubclavian
orbrachiocephalicarteryandleft-sided
arterialduct
■Rightaorticarchwithaberrantleftsubclavian
orbrachiocephalicarteryandright-sided
arterialduct
Otheranomaliesthatmayhaveclinicalsignificanceincludethecervicalaortic
arch,isolatedoriginoftheleftorrightsubclavianarteryfromapulmonary
artery,anddouble-barreled,ordoublelumen,aorticarch.
