Partial vascular ring Left aortic arch and anomalous right subclavian artery. In this case, right subclavian artery arises as the 4th branch in an otherwise normal aortic arch, passes upward and to the right behind esophagus. Symptoms Symtoms manifest as harsh cry, inspiratory stridor, dysphagia, chronic cough, bronchopneumonia, poor growth, failure to thrive, difficulty feeding, respiratory distress, wheezing, cyanosis, and hyperinflation of the lungs. Surgical Intervention Surgical intervention is indicated when symptoms are severe. Approach is left posterolateral thoracotomy in most cases, identification and division of rings usually corrects the problem.
Right thoracotomy is used for left sided aortic arch and right sided ligamentum arteriosus.