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It is well known that the magnetic resonance is the best study to define this malformation. In this patient, it was the cardiac catheterization which allowed estridorr define the structures that constituted the vascular ring. The patient was surgically treated in a successful way. The embryological knowledge of the transformations of the aortic arches offers great assistance in the understanding of all the types of vascular rings.

The term vascular ring is referred to the alterations of the aortic arches in which the trachea and the esophagus are surrounded by these structures. They are estridof in complete and partial; the former are the double aortic arch and the latter come from the aberrant origin of a subclavian artery, or arterial ligament or duct, counterside to the aortic arch.

The derinicion and more characteristic signs are: The moment of the presentation is varied, but it normally occurs in the neonatal period.


Female patient, 11 months old, referred to our Institute for vomits and laryngeal stridor occurring since the neonatal age. The echocardiogram did not find any intracardiac defect. The magnetic resonance did not defined accurately the structures which formed the vascular ring.

The angiography showed right aortic arch from which the arteries emerged in this order: Left subclavian artery was pull by a ligament which began from definiclon retroesophagic diverticulum from the estridpr aorta Figs. Surgical resection of the diverticulum, and section of the ligament was done so disappearing the digestive, and respiratory symptoms. The embryonic aortic arches system are bilateral vessels which connect the ventral and dorsal aortas, this produces a bilateral vascular system that surrounds the fore gut intestine from which the trachea and the esophagus come from.


The distal parts of the first and second arches disappear close to the dorsal aorta, and the proximal areas of them close to the ventral aorta keep on as hyoid and maxillary arteries respectively, which are branches of the external carotid artery. The third aortic arches persist and form the proximal parts of the internal carotid arteries.

On the other side the dorsal aorta between the third and fourth aortic arches known as carotid ducts, involute too.

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The fourth aortic arches persist encircling the anterior gut, this symmetry gives up an asymmetric pattern when one segment of the right dorsal aorta normally involutes between the seventh segmental artery and the place of union of both dorsal aortas which determines the formation of the aortic arch to the left. In such situation the left ventral aorta forms the ascendent portion, the fourth left aortic arch originates the transversal part, definicjon the left dorsal aorta gives rise the descendant portion of the left aortic arch.

The right ventral aorta give origin to the brachycephalic arterial trunk, from which the right common carotid artery and the right subclavian artery emerge, this last one has estridr tripartite origin, the proximal part derives from the right fourth aortic arch, the intermediate segment from the right dorsal aorta between this arch and the origin of the seventh segmentary artery, this last one constitutes the distal part. The sixth aortic arches originate the proximal portions of the branches of the pulmonary artery and the right and left arterial ducts, the right one usually disappears and the left one keeps or remain patent during fetal life.

The Kommerell’s diverticulum represents the persistency of the distal segment of double aortic arch, generally the left one which the proximal segment is atretic or disappears.

Usually it is not associated with other congenital heart disease, some authors have reported the ventricular septal defect as the most frequent malformation, other series mention aortic coartation, tetralogy of Fallot and transposition of defimicion great arteries. The clinical manifestations of the vascular ring and the seriousness will depend directly on the compression degree, in most of the patients the symptoms will appear before one month old, among the most known are the persistent stridor and feeding difficulty.


The cardiac catheterization is indicated when there is a confusion over the structures that form the vascular ring as esttidor was in the case herewith.

The surgical treatment is indicated in patients with symptoms of airway or esophageal compression. Cina reported a surgical mortality of 8. Surgical treatment of vascular rings: The Mayo Clinic experience. Mayo Clin Proc ; Vascular anomalies causing tracheoesophageal compression.

Review of experience in children. J Thorac Cardiovasc Surg ; 97 5: Anomalies of derivatives of the aortic arch system. Mayo Clin North Am ; Kommerell and Kommerell’s diverticulum. Texas Heart Inst J ; 29 2: Malformations of the aortic system manifested as vascular rings. Lav Invest ; 2: Dysphagia and stridor due to right aortic arch with Kommerell’s diverticulum.

Stridor in a 6 week old infant caused by right aortic arch with aberrant left subclavian artery. J Am Board Fam Pract ; 12 3: Two cases of “asthma” revealing a diverticulum of Kommerell.

Respiration ; 69 5: Aneurysm of aberrant right subclavian corrected ar tery arising from diverticulum ofKommerell. Report of a case with tracheal compression. Eur J Cardiothorac Surg ; 12 1: Surgical repair of right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum.

J Thorac Cardiovasc Surg ; 75 2: A cohort study and review of the literature. J Vase Surg ; Aneurysm of aberrant subclavian artery with a review of definixion literature. J Vase Surg ; 2: Introduction The term vascular ring is referred to the alterations of the aortic arches in which the trachea and the esophagus are surrounded by these structures.

Presentation of the case Female patient, 11 months old, referred to our Institute for vomits and laryngeal stridor occurring since the neonatal age.