Abstract
During a routine cadaver dissection performed by first year medical students at Oakland University William Beaumont School of Medicine, a 60‐year‐old female cadaver was found to have right aortic arch with mirror image branching (RAMI). The descending aorta was observed to pass to the right of the midline and subsequently to cross left, anterior to the esophagus, returning to its typical orientation at the aortic hiatus. This defect involves a mirror image branching in which a left brachiocephalic trunk, right common carotid artery, and right subclavian artery emerging directly from the aortic arch proximal to distal. The right recurrent laryngeal nerve passes under the aortic arch while the left recurrent laryngeal nerve was located more superiorly, passing underneath the left subclavian artery. The heart presented in its typical orientation with the apex located to the left of midline with no noted abnormalities of the pulmonary trunk or vascular ring surrounding the trachea. The aortic arch was studied in 24 formalin fixed cadavers (13 female, 11 male, average age 80) which had been dissected by first year medical students. Only 1 of the 24 specimens (4.17%) had a congenital aortic arch and branching defect while the remaining 23 did not display any aortic arch or branching abnormalities. After review of the published clinical literature, this variation appears consistent with RAMI and situs solitus which has been found in <0.1% of the general population. Studies have shown that 75–85% of cases with this defect are associated with cyanotic congenital heart disease, which makes early detection and follow‐up with pediatric cardiology essential. Other considerations for cardiac patients presenting with RAMI and situs solitus include accurate procedural imaging to provide safe and effective interventional care.
Published Version
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