![]() Pathogenetic considerations are explored, with a focus on flow-related vascular development and the role of deletions within chromosome 22q11. We have observed two basic patterns of this lesion: (1) with associated abnormalities of the proximal left pulmonary artery, (2) with a vascular ring formed by a ductus arteriosus or ligamentum from the descending aorta to the left pulmonary artery. A right aortic arch with mirror-image branching of the brachiocephalic vessels and no associated intracardiac anomalies is extremely uncommon. Two of these patients have undergone repeat magnetic resonance imaging, 1 of whom had mild residual tracheal compression. At a median follow-up of 7 years (15 months to 12 years), the patients who underwent division of the ring are all alive and asymptomatic. Two of the 6 patients who underwent evaluation for chromosome 22q11 deletion were found to have the deletion. She had no history of cardiovascular disease. During a routine cadaver dissection performed by first year medical students at Oakland University William Beaumont School of Medicine, a 60-year-old female cadaver was found to have right aortic arch with mirror image branching (RAMI). A 79-years-old-female was admitted to the Emergency Department for dyspnea and chest pain. None of the patients with stenosis or atresia of the LPA have undergone intervention. We report a case of a 79 years old woman with right aortic arch with mirror image branching (RAMI) discovered as incidental finding. All 6 of the patients with a vascular ring underwent division of the ductus arteriosus or ligamentum through a left lateral thoracotomy. Six patients were evaluated for deletion within the DiGeorge critical region of chromosome 22q11. Six patients had a vascular ring formed by a ductus arteriosus or ligamentum arteriosum from the descending aorta to the left pulmonary artery. These included 2 with bilateral ductus arteriosus. ![]() Of these, 4 had stenosis ( n= 2) or atresia ( n= 2) of the proximal left pulmonary artery. Eleven patients with a mirror-image right aortic arch and no intracardiac anomalies have undergone evaluation at our institution since 1987. The Edwards classification describes three types: RAA (right aortic arch) with ALSA (aberrant left subclavian artery), RAA with mirror image branching, and RAA with isolation of the left subclavian artery (LSA) 1, 2. Pathogenetic factors of this anomaly, and associated development of the derivatives of the pharyngeal arches, have not been explored extensively. We present a 74-year-old female with a right aortic arch and aberrant left subclavian artery that was discovered after a fall. Aortic arch anomalies are important to recognize as they may have important implications in management. It is unusual to have a right aortic arch with mirror-image branching of the brachiocephalic vessels and no associated congenital cardiac anomalies. The most common types of right aortic arches are mirror image branching or an aberrant left subclavian artery. ![]()
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