Symptomatic anomalies of the aortic arch.

Twenty-eight patients with anomalies of the aortic arch producing compression of the trachea and the esophagus have undergone surgical correction at this hospital since 1949. Of the vascular rings encountered, 15 had a double aortic arch and eight, a right aortic arch with a constricting ligamentum arteriosum. Five had an aberrant right subclavian artery passing posterior to the esophagus producing dysphagia. The patients with the double aortic arch were all infants. Two of the patients with a right arch and constricting ligamentum arteriosum and one patient with a retroesophageal subclavian artery were adults. Stridor from pressure on the trachea was the common symptom in the infants. The diagnosis was confirmed by esophagograms; aortography was less helpful. The surgical approach was the same for all of the anomalies, through a posterolateral incision in the left fourth interspace. For the double arches, the smaller limb, usually the anterior, was divided. Division of the ligament relieved the constriction of the right aortic arches, and the anomalous right subclavian artery was divided near the aorta. There were no hospital deaths, but one infant with a double aortic arch operated upon at the age of two weeks and with a tracheostomy died at home seven months later.