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Pathogenesis of solitary right aortic arch: a mass effect hypothesis based on observations of serial human embryonic sections

Published online by Cambridge University Press:  05 October 2015

Zhe W. Jin ,
Tomonori Yamada ,
Ji H. Kim ,
José F. Rodríguez-Vázquez ,
Gen Murakami  and
Keiji Arakawa
Zhe W. Jin*
Affiliation:
Department of Anatomy, Histology and Embryology, Yanbian University Medical College, Yanji City, Jilin Province, China
Tomonori Yamada
Affiliation:
Division of Internal Medicine, Iwamizawa Asuka Hospital, Iwamizawa, Japan
Ji H. Kim
Affiliation:
Department of Anatomy, Faculty of Medicine, Chonbuk National University, Jeonju, Korea
José F. Rodríguez-Vázquez
Affiliation:
Department of Anatomy and Embryology II, Faculty of Medicine, Complutense University, Madrid, Spain
Gen Murakami
Affiliation:
Division of Internal Medicine, Iwamizawa Asuka Hospital, Iwamizawa, Japan
Keiji Arakawa
Affiliation:
Division of Internal Medicine, Iwamizawa Asuka Hospital, Iwamizawa, Japan
*
Correspondence to: Z. W. Jin, MD, PhD, Department of Anatomy, Histology and Embryology, Yanbian University Medical College, No. 977 Gongyuan Road, Yanji, Jilin 133002, China. Tel: +86 433 243 5115; Fax: +86 433 243 5103; E-mail: [email protected]
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Abstract

In general, solitary right aortic arch carries the left-sided ductus arteriosus communicating between the left subclavian and pulmonary arteries or the right-sided ductus connecting the descending aorta to the left pulmonary artery. Serial sections of fifteen 5- to 6-week-old embryos and ten 8- to 9-week-old fetuses suggested that the pathogenesis was unrelated to inversion due to dysfunction in gene cascades that control the systemic left/right axis. With inversion, conversely, the ductus or the sixth pharyngeal arch artery should connect to the right pulmonary artery. The disappearance of the right aortic arch started before the caudal migration of the aortic attachment of the ductus. Sympathetic nerve ganglia developed immediately posterior to both aortae, with a single embryonic specimen showing a large ganglion at the midline close to the union of the aortic arches. These ganglia may interfere with blood flow through the distal left arch, resulting in the ductus ending at the descending aorta behind the oesophagus. In another fetus examined, a midline shift of the ductus course resulted in the trachea curving posteriorly. Therefore, solitary right arch is likely to accompany abnormalities of the surrounding structures. The timing and site of the obstruction should be different between types: an almost midline obstruction near the aortic union needed for the development of the left-sided ductus and a distal obstruction near the left subclavian arterial origin needed for the development of the right-sided ductus. A mass effect of the sympathetic ganglia may explain the pathogenesis of any type of anomalous ductus arteriosus shown in previous reports of the solitary right arch.

Keywords

Right aortic archductus arteriosuspharyngeal arch arteriesinversionhuman embryo
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 2 , March 2017 , pp. 359 - 368
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Copyright
© Cambridge University Press 2015 

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References

1. D’Cruz, IA, Cantez, T, Namin, EP, Licata, R, Hastreiter, AR. Right-sided aorta: part II: right aortic arch, right descending aorta, and associated anomalies. Br Heart J 1966; 28: 725–739.Google Scholar
2. Hastreiter, AR, D’Cruz, IA, Cantez, T. Right-sided aorta: part I: occurrence of right aortic arch in various types of congenital heart disease. Br Heart J 1966; 28: 722–725.Google Scholar
3. Knight, L, Edwards, JE. Right aortic arch: types and associated cardiac anomalies. Circulation 1974; 50: 1047–1051.Google Scholar
4. McElhinney, DB, Hoydu, AK, Gaynor, JW, Spray, TL, Goldmuntz, E, Weinberg, PM. Patterns of right aortic arch and mirror-image branching of the brachiocephalic vessels without associated anomalies. Pediatr Cardiol 2001; 22: 285–291.Google Scholar
5. Mano, Y, Adachi, N, Murakami, G, Yokoyama, A, Dodo, Y. Human situs inversus of the thoracoabdominal structures. Anat Sci Int 2006; 81: 7–20.CrossRefGoogle ScholarPubMed
6. Bhatnager, KP, Wagner, CE, Kuwabara, N, Nettleton, GS, Campbell, FR. Right-sided aorta: a cadaver report and brief discussion of human aortic arch anomalies. Ann Anat 2000; 182: 559–562.Google Scholar
7. Bashar, AH, Kazui, T, yamashita, K, Trada, H, Washiyama, N, Suzuki, K. Right aortic arch with aberrant left subclavian artery symptomatic in adulthood. Ann Vasc Surg 2006; 20: 529–532.CrossRefGoogle ScholarPubMed
8. Le Bret, E, Leobon, B, Roubertie, F, et al. Right aortic arch and isolated left innominate artery from a left sided patent ductus arteriosus: a very rare aortic arch anomaly. J Pediatr Surg 2009; 44: E29–E31.Google Scholar
9. Paparo, F, Bacigalupo, L, Melani, E, Rollandi, GA, De Caro, G. Cardiac-MRI demonstration of the ligamentum arteriosus in a case of right aortic arch with aberrant left subclavian artery. World J Radiol 2012; 4: 231–235.Google Scholar
10. Ng, MY, Thavendiranathan, P, Crean, AM, Li, Q, Deva, DP. Left-sided patent ductus arteriosus in a right-sided aortic arch. Case Rep Radiol 2014; Epub ahead of print, doi: 10.1155/2014/896071.Google Scholar
11. Schlesingner, AE, Mendeloff, E, Sharkey, AM, Spray, TL. MR of right aortic arch with mirror-image branching and a left ligamentum arteriosum: an unusual cause of a vascular ring. Pediatr Radiol 1995; 25: 455–457.Google Scholar
12. Tanaka, H, Yamaki, K, Saga, T, et al. A rare case of the right-sided aortic arch that has the right subclavian artery as the last branch. Kurume Med J 1997; 44: 147–152.Google Scholar
13. Jones, TK, Garabedian, H, Grifka, RG. Right aortic arch with isolation of the left subclavian artery, moderate patent ductus arteriosus, and subclavian steal syndrome: a rare case aortic arch anomaly treated with the Gianturco-Grifka vascular occlusion device. Catheter Cardiovasc Interv 1999; 47: 320–322.Google Scholar
14. Han, JJ, Sohn, S, Kim, HS, Won, TH, Ahn, JH. A vascular ring: right aortic arch and descending aorta with left ductus arteriosus. Ann Thorac Surg 2001; 71: 729–731.Google Scholar
15. Madan, N, Schneider, DJ, Jacobs, ML. Right aortic arch, isolated left subclavian artery and ductus arteriosus with normal intracardiac anatomy: rare manifestation of chromosome 22q11 deletion. Pediatr Cardiol 2006; 27: 781–783.CrossRefGoogle ScholarPubMed
16. Zhao, J, Liao, Y, Gao, S. Right aortic arch with retroesophageal left ligamentum arteriosum. Tex Heart Inst J 2006; 33: 218–221.Google Scholar
17. Iliescu, DG, Comanescu, AC, Tudorache, S, Cernea, N. Right aortic arch with patent right ductus arteriosus and normal heart. Ultrasound Obstet Gynecol 2012; 40: 115–116.CrossRefGoogle ScholarPubMed
18. Nakata, M, Suzuki, Y, Hotta, N, Sunasaka, T, Numa, F. Prenatal diagnosis of right aortic arch with mirror-image branching without associated anomalies. J Obstet Gynaecol Res 2013; 39: 1077–1080.Google Scholar
19. Bhat, SP, Girish, GS, Mahimarangaiah, J, Manjunath, CN. Right aortic arch with retroesophageal left innominate artery and left patent ductus arteriosus: a rare vascular ring. World J Pediatr Congenit Heart Surg 2015; 6: 146–148.Google Scholar
20. Abe, M, Isobe, T, Atsumi, N. Right aortic arch with isolation of the left subclavian artery and bilateral patent ductus arteriosus. Pediatr Cardiol 2000; 21: 497–499.Google Scholar
21. Bronshtein, M, Zimmer, EZ, Blazer, S, Blumenfeld, Z. Right ductus arteriosus: facts and theory. Eur J Obstet Gynecol Reprod Biol 2011; 159: 282–288.CrossRefGoogle ScholarPubMed
22. Barry, A. The aortic arch derivatives in the human adults. Anat Rec 1951; 111: 221–238.Google Scholar
23. Naito, M, Yu, HC, Kim, JH, Rodriguez-Vazquez, JF, Murakami, G, Cho, BH. Fetal topographical anatomy of the inferior vena cava, coronary sinus and pulmonary veins: a background of Chiari’s network variations. Clin Anat 2015; 28: 627–637.CrossRefGoogle Scholar
24. Yamamoto, M, Honkura, Y, Rodríguez-Vázquez, JF, et al. Switching of the laryngeal cavity from the respiratory diverticulum to the vestibular recess: a study using serial sagittal sections of human embryos and fetuses. J Voice 2015; Epub ahead of print, doi: 10.1016/j.jvoice.2015.05.003.Google Scholar
25. Koizumi, K, Homma, T, Sakai, T. A case of dissection of the right aortic arch, with consideration on the development of its major branches and ductus arteriosus. Kaibogaku Zasshi 1994; 69: 252–260. (in Japanese with English abstract)Google Scholar
26. Horiguchi, M, Yamada, T, Uchiyama, Y. A case of retroesophageal right subclavian artery-with special reference to the morphology of cardiac nerves. Kaibogaku Zasshi 1982; 57: 1–8. (in Japanese with English abstract)Google Scholar
27. Konishi, M, Kikuchi, M. A case of the right aortic arch with the left subclavian artery as its last branch. Kaibogaku Zasshi 1992; 67: 19–27. (in Japanese with English abstract)Google Scholar
28. Kasai, T, Aiyama, S, Kihara, S, Takahashi, G. Studies on the anomalies of the arch of aorta in human fetuses of newborns. Kaibogaku Zasshi 1969; 44: 213–221.Google Scholar
29. Aizawa, Y, Isogai, S, Izumiyama, M, Horiguchi, M. Morphologies of the primary arterial trunks of the forelimb in the rat embryos: the trunks originate from the lateral surface of the dorsal aorta independently of the intersegmental arteries. Anat Embryol (Berl) 1999; 200: 573–584.Google Scholar