Adkins R B, Maples M D, Graham B S, Witt T T, Davies J
Am Surg. 1986 May;52(5):238-45.
Aortic arch anomalies typically become evident in early childhood with clinical manifestations such as cyanosis and feeding problems. Although uncommon and therefore not often considered, this developmental defect can cause dysphagia in the adult. The double aortic arch is the most common vascular ring in infants. Less well-known vascular rings in the adult are a right aortic arch with constricting left ligamentum arteriosum and an aberrant right subclavian artery. Dysphagia is common secondary to the constriction of the esophagus. Two patients recently presented to the Metropolitan Nashville General Hospital with prolonged history of dysphagia. Studies included barium swallow and aortogram, which showed right aortic arch in both patients with constricting left ligamentum arteriosum. The treatment for these symptomatic anomalies was division and excision of the ligamentum arteriosum and freeing of the esophagus. A right aortic arch on the chest roentgenogram in a patient with dysphagia should suggest a vascular ring as the etiology. If this is suspected, diagnosis is easily made and surgical treatment is effective. The relevant embryology will be discussed.
主动脉弓异常通常在儿童早期就会表现出明显的临床症状，如发绀和喂养问题。尽管这种发育缺陷并不常见，因此常常不被考虑，但它在成人中可导致吞咽困难。双主动脉弓是婴儿中最常见的血管环。在成人中不太为人所知的血管环是伴有左动脉韧带缩窄的右主动脉弓和迷走右锁骨下动脉。吞咽困难通常是由食管受压继发引起的。最近有两名患者因长期吞咽困难就诊于纳什维尔都会总医院。检查包括吞钡造影和主动脉造影，结果显示两名患者均为伴有左动脉韧带缩窄的右主动脉弓。对于这些有症状的异常情况，治疗方法是切断并切除动脉韧带，松解食管。吞咽困难患者胸部X线片上显示右主动脉弓时，应考虑血管环为病因。如果怀疑是这种情况，诊断很容易做出，手术治疗也很有效。本文将讨论相关的胚胎学。
