Aortic arch anomalies classifications double aortic arch

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Keri Shafer, M.D. [3] Priyamvada Singh, MBBS [[4]]

Assistant Editor-In-Chief: Kristin Feeney, B.S. [[5]]

Double Aortic Arch

Double aortic arch has been classified as type 1 (both arches patent) and type 2 (one arch atretic). The atretic arch is almost invariably the left. Type 2 double arches may be subclassified according to the position of the atresia. Subtype 1 the atretic segment is between ductus arteriosus and descending aorta; subtype 2 it is between left subclavian artery and ductus arteriosus; subtype 3 it is between left common carotid artery and left subclavian artery; and subtype 4 the atresia is between ascending aorta and left common carotid artery. In subtype 3 it is common for the left subclavian artery to arise from a diverticulum. The diverticulum has the same embryologic origin as that originally described by Burckhard Kommerell, and may reasonably be referred to as a Kommerell’s diverticulum.

Double aortic arch is an important vascular ring anomaly, as the arches and atretic ligamentous cords surround and potentially compress the trachea and oesophagus. A clue as to the presence of double arch on barium swallow is the presence of focal oesophageal narrowing in both the AP and transverse directions.

Diagnosis

A double aortic arch may be observed through multiple diagnostic techniques:

• MRI
• CT