Double aortic arch and airway

Description

This model highlights the embryological origins of the aortic arch from the pharyngeal arches and paired dorsal aortae. Normally the aortic blood twists it's way selectively through the fourth left arch. Through lack of flow, the fourth right arch dissipates distally and breaks free. Thus the third and fourth right pharyngeal arches blend proximally as the inominate artery, the first branch of the aortic arch. The third right arch is the right common carotid artery. In the situation of double aortic arch, the aortic blood flow has persisted in both fourth arches [3,4]. The common carotids (third pharyngeal arches) are seen to come off anteriorly, one on each side and the subclavian arteries (somatomeric branches) come off adjacent the distal aspects of the fourth arches. In this particular case, the left arch lent itself to transection and oversewing distal the left subclavian to relieve symptoms of stridor and dysphagia. Interestingly, this creates a right aortic arch with mirror branch pattern. Beautiful!