Anomalies of the aortic arch - An unrecognised clinical problem in South Africa?

In an analysis of 8 cases of aortic arch anomalies in patients presenting at a tertiary care hospital in South Africa, not 1 of the cases was recognised by the referring or attending physicians. In 7 of the 8 cases there were signs on the chest radiographs suggestive of aortic arch anomalies which were missed in all but 1 case. The diagnosis of aortic arch anomalies was made with the combination of echocardiography and barium oesophagography, with the echocardiogram the major contributor. Precise anatomy was obtained either by digital subtraction angiography or cine angiography. To interpret the angiography correctly and detect all associated anomalies, a thorough knowledge of the embryology and development of aortic arches is needed. A practical classification is also proposed.