Left aortic arch with right descending aorta and severe coarctation: an unusual “vascular clamp” with airway compression

Abstract

Left aortic arch with right descending aorta is a rare congenital anomaly. We describe the clinical presentation of this unusual anomaly associated with cardiorespiratory compromise from severe aortic obstruction and left main bronchus compression. The anatomical peculiarities, embryological basis, and surgical solutions are presented.

A left circumflex aorta with a displaced thoracic duct in a 94-year-old male cadaver: a case report with discussion on embryology

“…However, if the ductus or ligamentum arteriosum is located on the left side, the vascular ring is incomplete [9], as found in the present case. Even though a LCA with a left patent ductus arteriosus does not form a complete vascular ring, it can still cause severe respiratory compression, as shown by Sheth et al [20] in a case of a 2-month-old patient whose left main bronchus was obstructed. In patients aged two years old or less, the symptoms of a vascular ring are typically respiratory in nature, whereas older children and adults suffer mostly from dysphagia, less frequently the former [25].…”

Left bronchial compression after aortic arch reconstruction for coarctation of the aorta

“…Reportedly, having a midline or right-sided descending aorta already causes extrinsic compression of the carina and left main bronchus. 13,14 Additionally, a preoperative right-sided descending aorta might also be a risk factor for airway obstruction after aortic arch reconstruction. 15 McKenzie et al showed that vascular compression of the left main bronchus after AAA could be associated with having a midline descending aorta, which could occur in patients with vascular rings with or without previous division.…”