Diagnosis and Treatment of Aortic Rings

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AORTIC rings constitute a functionally important group of anomalies of the aortic arch which may compress the trachea, esophagus, or both. Many are amenable to surgical correction. It is our purpose to present the available methods by which they may be recognized, and to discuss the problems involved in treatment.

Edwards1 has presented a logical and complete classification of the possible anatomic variants of the aortic arch system, based upon his recognition of the fact that a functioning double aortic arch exhibits the most complete adult representation of the six embryonic arches. From this basic pattern he classified the reported anomalies, and predicted others, on the premise that atresia of either arch at any given level would cause a specific anatomic variant of the complete pattern.

We believe that a simpler clinical classification, derived from that of Edwards, is useful in the practical approach to the recognition of these anomalies. We have limited the scope of the classification to those elements which are clinically recognizable in the living patient. In our experience it has led to reasonably precise preoperative evaluation of the problems encountered. Its usefulness depends upon the physician’s ability to locate the position of the upper portion of the descending aorta. In each group the fundamental pattern is an anterior aortic arch with the descending aorta on the homolateral side. This is the normal structure of the aorta when it occurs on the left, and when seen on the right it is simply the mirror image of the. . .



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