A vascular ring is when vascular structures encircle the trachea and oesophagus and can lead to compression of these structures, and in the current era, these are commonly diagnosed prenatally. This pictorial piece describes the anatomical features of the three most encountered vascular rings in contemporaneous practice, namely, right aortic arch with left-sided ductal ligament and aberrant left subclavian artery; right aortic arch with left-sided ductal ligament and mirror image branching pattern and double aortic arch. A combination of fetal, paediatric and surgical images are used to display the anatomical features.

Double aortic arch (DAA) is a rare congenital vascular anomaly resulting in a complete vascular ring that encircles and compresses the trachea and esophagus, leading to respiratory and gastrointestinal symptoms. Accurate diagnosis and timely surgical intervention are essential for symptom relief and preventing complications. However, data on surgical outcomes and long-term follow-up are limited. This study retrospectively analyzed surgical outcomes and perioperative management of DAA to elucidate optimal diagnostic and therapeutic approaches. A retrospective cohort study enrolled patients undergoing DAA repair (August 2015-May 2024). Participants were stratified into isolated DAA or DAA with associated intracardiac anomalies groups. Demographic, operative, and outcome variables were compared. Among 10 patients undergoing double aortic arch repair, 6 comprised the isolated DAA group (3 males/3 females; mean age 3.70 ± 3.18 months; mean weight 6.28 ± 2.77 kg) and 4 had associated intracardiac anomalies (3 males/1 female; mean age 6.70 ± 6.12 months; mean weight 6.15 ± 3.59 kg). Isolated DAA patients and those with intracardiac anomalies showed no statistically significant differences in: symptom onset (28.17 ± 37.66d vs. 30.50 ± 41.96d), anatomic subtypes (dominant right arch 83% vs. 50%), extracardiac anomaly rates (50% vs. 75%), or clinical manifestations-respiratory (67% vs. 100%) and other systemic (17% vs. 75%) (all P > 0.05). All procedures were successfully completed with significantly shorter operative time in the isolated group (104.83 ± 22.23 vs. 233.25 ± 38.55 min, P < 0.001). No significant intergroup differences (P > 0.05) were observed in preoperative ventilation, blood loss, ventilator duration, Cardiac Intensive Care Unit stay, drainage duration, hospitalization, or complication rates. During mean 12.7-month follow-up (1-36 months), near-complete symptom resolution occurred in 9/10 survivors, with one death from respiratory failure in a comorbid patient 10 days post-discharge. Surgical repair of double aortic arch demonstrates acceptable safety and efficacy in both infants and children, with favorable short-to-midterm clinical outcomes regardless of concomitant intracardiac anomalies.

A double superior vena cava is a rare congenital vascular variation that may influence cardiovascular function and medical procedures. This report describes the morphology of a double superior vena cava identified in the body of an 87-year-old female donor. Anatomical dissection revealed two fully isolated superior venae cavae, with the right superior vena cava draining into the right atrium and the left superior vena cava draining into the coronary sinus. The brachiocephalic veins were absent, and the azygos system displayed an atypical configuration. The left external jugular vein also showed significant variation, featuring a superiorly located fenestration followed by a bifurcation that formed a venous ring encircling the clavicle. The anterior interventricular artery tunnelled into the myocardium, forming two myocardial bridges along the anterior interventricular sulcus before reaching the cardiac apex. These findings illustrate the diversity of vascular anatomy and emphasize the importance of recognizing such variants during diagnostic imaging and medical procedures.

This case report describes a congenital anomaly involving a right cervical aortic arch and an aberrant subclavian artery (ASA) leading to vascular ring (VR) formation. This anomaly is characterized by the presence of the aortic arch in the cervical region rather than the thoracic cavity. The ASA can contribute to the formation of a VR encircling the trachea and esophagus, potentially causing severe respiratory complications. Early diagnosis and effective management in pediatric patients are crucial, given the life-threatening risk of respiratory compromise. In this case, the patient was diagnosed prenatally and initially exhibited only mild respiratory symptoms. Over time, however, the patient developed breathing difficulties and recurrent infections secondary to the VR, which prompted bronchoscopy, microlaryngoscopy, and subsequent surgical intervention. The VR was surgically corrected through aortic uncrossing and reimplantation of the right subclavian artery. Fewer than five prior reports have documented a similar case, underscoring the importance of promptly recognizing the symptoms of a potential vascular anomaly to preserve airway integrity. This report contributes to establishing surgical criteria and intervention strategies, thereby enhancing preparedness for managing similar congenital cardiac abnormalities in the future.

Transcatheter aortic valve replacement (TAVR) is an established treatment for managing severe aortic stenosis. Preoperative planning requires cautious identification of the access route, which can be challenging in patients with anatomical abnormalities of the aorta. Double aortic arch (DAA) is a congenital condition where the aorta bifurcates into two separate vessels that encircle the trachea and esophagus, thereby forming a vascular ring. This condition accounts for ~1% of congenital cardiovascular anomalies. Previous reports on TAVR performed on patients with DAA are limited, and there is no consensus on the appropriate access route. Herein, we present an 85-year-old female patient with DAA and aortic stenosis who underwent a successful TAVR using the direct aortic approach.