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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: zwjin@ybu.edu.cn
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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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