Common origin of the innominate artery and left common carotid artery.
Origin of the left common carotid artery from the innominate artery.
Many authors consider that these two variants can be erroneously named "bovine" arch,
since the aortic arch of cattle is not presented in a similar way.
However,
other studies consider only the common origin of the innominate artery and left common carotid artery as a “bovine” arch.
Fig. 3
Both aortic arch branching pattern is found more often in blacks. The common origin of the IA and LCCA is seen in approximately 13% of patients.
The origin of the LCCA from IA variant is seen in 9% in the general population.
Fig. 4 Fig. 5
Anomalous origin of the left vertebral artery
The left vertebral artery (LVA) originating from the aortic arch is more prevalent in females,
and most studies report a prevalence between 3% and 8% in general population.
Fig. 6
LVA can arise from the aortic arch between LCCA and LSCA or after LSCA.
The first case is more common,
present in 75% of the cases in which the LVA originates from the aortic arch.
Left aortic arch with aberrant right subclavian artery
The most common anomaly of the left aortic arch is the aberrant right subclavian artery,
with a retroesophageal pathway,
with a prevalence of 0.5% to 2%.
Fig. 7
It is usually isolated but it can be associated with other congenital anomalies.
The majority of patients are asymptomatic,
but studies show that 10% of adults with this anomaly present symptoms resulting from extrinsic compression of the esophagus,
termed dysphagia lusoria.
Fig. 8
Diverticulum of Kommerell
The Kommerell diverticulum is a remnant of the dorsal aortic arch and it has been reported to be present in 20% to 60% of individuals with an aberrant subclavian artery. Fig. 9
There are described three types of aortic arch diverticulum:
Type 1: Diverticulum in a left-sided aortic arch with aberrant right subclavian artery.
Type 2: Diverticulum in right-sides aortic arch with aberrant left subclavian artery.
Type 3: Diverticulum at the aortic–ductal junction not associated with the subclavian artery (non-Kommerell diverticulum).
Single arterial trunk arising from the aortic arch
It is a very rare anomaly of aortic arch,
with a few cases cited in the literature,
and its cause remains uncertain.
It is believed the abnormality is due to a regression on an abnormal site of the fourth left aortic arch.
Fig. 10
This anomaly is characterized by a single trunk originating from the aortic arch and branching into the right subclavian artery,
right common carotid artery,
left subclavian artery and left common carotid artery.
Common trunk of the left vertebral artery and left thyrocervical trunk.
Studies show that the incidence of a common trunk of the LVA and left thyrocervical trunk arising from the subclavian artery is 0.58%.
Fig. 11
Right aortic arch
A right aortic arch is a rare congenital anomaly that results from the regression of a left dorsal aortic root.
It has a prevalence of 0.05% in adults and it can be associated with other congenital cardiac anomalies.
The classification is according to the branching pattern of the arch vessels as follows: right aortic arch with mirror-image,
right aortic arch with an aberrant left subclavian artery (ALSA),
right aortic arch with isolation of the left subclavian artery (LSA) and right aortic arch with an aberrant left innominate artery.
There is also another type: circumflex retroesophageal right aortic arch with an ALSA. Fig. 12 Fig. 13 Fig. 14
Pseudocoarctation of the aorta
Pseudocoarctation of the aorta is a rare congenital anomaly characterized by kinking or buckling of the descending aorta at the level of the ductus arteriosum.
Fig. 15
The anomaly does not cause obstruction or a gradient across the kinked segment,
therefore there are no haemodynamic abnormalities.
Coarctation of the aorta
Coarctation of the aorta consists of the localized shelf in the posterolateral aortic wall opposite to the ductus arteriosus.
It is found in 0.06% to 0.08% of the general population and in 5–7% of all congenital heart disease.
The most important physical finding is upper extremity hypertension. Fig. 16 Fig. 17
The location,
severity,
presence of collateral vessels and association with other anomalies may help differentiate coarctation of aortic pseudocoarctation.
Patent ductus arteriosus
The ductus arteriosus is a connection between the aorta and the pulmonary artery.
Isolated patent ductus arteriosus is found in approximately 10-12% of all congenital heart anomalies.
Fig. 15
Circumflex retroesophageal right aortic arch
The right circumflex retroesophageal aortic arch is an extremely rare presentation of the vascular rings,
but more common than the Circumflex retroesophageal left aortic arch.
It can cause tracheal compression,
causing respiratory symptoms. Fig. 18