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Congenital obstructive lesions of the right aortic arch
Doff B McElhinney, MD, Wayne Tworetzky, MD, Frank L Hanley, MD, Abraham M Rudolph, MD The Annals of Thoracic Surgery Volume 67, Issue 4, Pages (April 1999) DOI: /S (98)
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Fig 1 Schematic diagrams based on the hypothetic embryonic arch system showing differences in the development of normal great vessels (left) and three patterns of right aortic arch (RAA). The top row demonstrates the primitive arch system, with left (L) and right (R) third (III), fourth (VI), and sixth (VI) pharyngeal arches, distal pulmonary arteries (PA), seventh intersegmental arteries (VII), and dorsal aortas (DAo). Dark areas represent the segments that regress in the development of the corresponding mature arch anatomy, shown in the bottom row for each case. In normal development, the third pharyngeal arches contribute to the common carotid (CCA) and external carotid arteries; the fourth arches develop into the distal arch on the left (between the left common carotid and subclavian arteries) and the innominate artery on the right; the sixth arches contribute to the proximal branch pulmonary arteries and the ductus arteriosus (PDA); the seventh intersegmental arteries develop into the subclavian arteries (SCA); and the left dorsal aorta becomes the descending aorta, whereas the right dorsal aorta regresses. Three patterns of right arch branching are depicted in the diagrams to the right of the diagram of normal anatomy. The Annals of Thoracic Surgery , DOI: ( /S (98) )
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Fig 2 This schematic depiction of cervical right arch and two patterns of interrupted right arch is based on the model described in Figure 1. The diagrams on the left and in the center demonstrate interruption of a right aortic arch with aberrant origin or isolation of the left subclavian artery, respectively. The diagram on the right shows one of the typical patterns of right cervical arch, with direct aortic origin of the right internal (ICA) and external (ECA) carotid arteries (obstruction not shown). Note that the fourth pharyngeal arches regress bilaterally in all three scenarios. (IAA = interruption of the aortic arch; other abbreviations are as in Fig 1.) The Annals of Thoracic Surgery , DOI: ( /S (98) )
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