Both diseases are typically diagnosed in childhood, but occasionally asymptomatic cases may be incidentally detected through imaging in adulthood. The PDA can arise from the right subclavian artery in a left aortic arch or from a diverticulum when in conjunction with an aberrant right subclavian. Both the right-sided aortic arch with mirror-image branching (RAMI) and the congenital absence of the left pulmonary artery are sporadic congenital defects. Other documented positions of the PDA in patients with tetralogy of Fallot include origins from an aberrant left subclavian artery in a right aortic arch, from a diverticulum which also gives off the aberrant left subclavian artery, and from the left common carotid artery in the context of aberrant left subclavian artery, and, rarely, there can be a right PDA connected to the right pulmonary artery. While this is the most common anatomical arrangement in tetralogy of Fallot with a right aortic arch, it is still an extremely rare observation in adult clinical practice. All the head and neck vessels are connected in the same position and provide blood to the correct part of the upper body. The most common types of right aortic arches are mirror image branching or an aberrant left subclavian artery. Right aortic arch with mirror image branching pattern The aorta, the large body vessel, branches to the right rather than the left. This configuration may form a vascular ring with associated symptoms of dysphagia (though this was not the case in our patient). The right aortic arch is a rare anomaly that is usually associated with other congenital anomalies but can occur in isolation. With cyanotic heart disease, especially the tetralogy of Fallot and truncus arteriosus, the right arch is almost invariably the mirror image of the normal left. Right-sided aortic arch with mirror image branching and situs solitus: a case of a 79 years old woman. She had no history of cardiovascular disease. A 79-years-old-female was admitted to the Emergency Department for dyspnea and chest pain. The first branch left the innominate artery, the second right carotid, and the third right subclavian. Right aortic arch, mirror image branching, coronary artery bypass surgery Date received: 20 December 2020 accepted: 16 June 2021. We report a case of a 79 years old woman with right aortic arch with mirror image branching (RAMI) discovered as incidental finding. The right ductus arteriosus also undergoes involution and the remaining left ductus arteriosus usually originates from the left brachiocephalic artery or subclavian artery. Mirror image branching of the head and neck vessels. This article describes the features, clinical importance, and management of the same. In Edward's developmental model of the aortic arch the development of the right-sided aortic arch with mirror image branching occurs due to involution of the dorsal segment of the left arch between the left subclavian artery and descending aorta. The right aortic arch with mirror-image branching is a rare anomaly.
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