EMBRYOLOGY OF AORTIC
ARCH ANOMALIES
EMBRYOLOGY
The first arteries to
appear in the embryo
Right & left
primitive aortae.
Continuous with the
endocardial tubes.
Each one – dorsal &
ventral portion.
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EMBRYOLOGY
Ventral aortae
partly fuse
Aortic sac.
Unfused parts
remain as the Rt &
Lt horns of the sac.
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EMBRYOLOGY
Six pairs of arterial arches
appear, connecting the
dorsal & ventral aortae.
All are never present
simultaneously.
Selective regression &
persistence of these arch
vessels forms the major
arteries of head, neck &
thorax.
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EMBRYOLOGY
The 1st, 2nd & 5th
arches disappear.
Aortic sac remains
connected to the 3rd,
4th & 6th arches.
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EMBRYOLOGY
Spiral septum formed in
the truncus arteriosus
extents into the aortic sac .
Ascending aorta &
Pulmonary trunk –
Truncus arteriosus
Blood from :-
Pulmonary trunk 6th arch.
Ascending aorta 3rd & 4th
arches.
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EMBRYOLOGY
Aortic arch -
Ventral part of
aortic sac & its lt
horn.
Lt 4th arch artery.
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EMBRYOLOGY
Descending aorta
Lt dorsal aorta below
the attachment of the
4th arch.
Fused median vessel.
Brachiocephalic A
Rt horn of the aortic
sac.
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EMBRYOLOGY
3rd arch Carotid.
6th arch Pulmonary
arteries & Ductus
arteriosus.
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EMBRYOLOGY
Rt subclavian
Rt 4th arch artery
7th intersegmental A
Lt subclavian
7th intersegmenal A
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NORMAL ANATOMY
Branches of aortic
arch:
Brachiocephalic A
Left common
carotid A
Left subclavian A
74% - Normal
branching.
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Common variants
Brachiocephalic & LCCA share common origin
( 25% - 30 % ) Bovine configuration
LCCA arises from brachiocephalic trunk(7%)
LCCA & LSCA form a left sided brachiocephalic
trunk (1 to 2%)
Left vertebral artery arises directly from arch
(0.5%) – usually between LCCA & LSCA &
often hypoplastic.
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AORTIC ARCH ANOMALIES
Hypothetical double
arch.
Each has separate
carotid, subclavian &
ductus arteriosus.
Esophagus & trachea are
within.
Anomalies of arch are
due to breaks at various
points in this concept.
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Normal left arch
Posterior part of
right arch involutes.
Branches :
brachiocephalic, left
common carotid
and left subclavian.
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AORTIC ARCH ANOMALIES
Double arch
Double arch with atretic segment
Right arch with mirror branching
Right arch with aberrant left subclavian artery
Left arch with aberrant right subclavian
artery.
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DOUBLE AORTIC ARCH
Descending aorta in 75% on left , in 25% on
right side.
Smaller arch is more anterior & larger arch
is more posterior.
Right arch larger & more cephalad than left
in 80%.
As a rule the descending aorta is
contralateral to side of dominant arch.
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Double aortic arch
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Barium swallow shows bilateral impressions
on frontal view
Posterior impression on lateral view
Bilateral esophageal
indentation with a
reversed S - shaped
configuration ( right
indentation higher
than left )
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Broad horizontal posterior
indentation at the level of
3rd or 4th thoracic vertebra
( by right arch crossing
posteriorly to join left arch)
DD: Aberrant subclavian A.
with diverticulum
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Double arch with atretic
segment
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RIGHT AORTIC ARCH
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Right aortic arch with mirror
branching
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Right arch with aberrant left
subclavian
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Right arch with aberrant left
subclavian artery
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Left arch with aberrant right
subclavian artery
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Left arch with aberrant right
subclavian artery
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Kommerell diverticulum
It refers to bulbous dilatation of origin of aberrant right or
left subclavian artery.
may be asymptomatic, or cause symptoms of
oesophageal or tracheal obstruction.
CXR - A small rounded density may be seen lateral to
the trachea.
CT/MRI
Typically shows bulbous enlargement of proximal
subclavian artery at its origin from aortic arch, posterior
to oesophagus.
Complication- aneurysm formation
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Kommerall diverticulum
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