Thoracic arterial arch anomalies.

THORACIC ARTERIALI ANOMALIES were formerly regarded as having little significance except when they produced tracheal or esophageal obstruction. As thoracic surgical procedures become more prevalent in the smaller or community hospitals, the case concentration will become less, and many of these anomalies may go unrecognized. Recognition of the many types of vascular disarrangement thus assumes a greater clinical significance. Although detailed information is available concerning specific anomalies, general surveys of the over-all problem are lacking. By reviewing 41 selected instances of arterial arch anomalies that we have encountered either on the Thoracic Surgery Service, Walter Reed General Hospital, or in the Cardiovascular Collection of the Armed Forces Institute of Pathology and referring to those described by others, it is hoped to stimulate interest and discussion of these intricate problems. Many parallels for the study of these anomalies may be found in vertebrate anatomy. Although Hommell had published a beautiful illustration of a constricting double aortic arch in the human in 1737, it remained for Jex-Blake2 to suggest in 1926 the feasibility of surgical correction based on the autopsy findings of this anomaly in a puppy which he had observed with stridor and dysphagia. Since Gross'3 first successful surgical correction of a vascular ring in June 1945, much progress has been made in the diagnosis and treatment of these anomalies. The double aortic arch is found normally in some classes of vertebrates. Figure 1 shows the long pairing of the dorsal aortae as seen