“Heart Sign” with Double Aortic Arch

Double aortic arches are rare congenital malformations resulting from persistence of the right and left aortic arches, as opposed to normal regression of the left aortic arch. These vascular malformations can cause vascular rings since they encompass the trachea and esophagus, and lead to swallowing difficulties or respiratory difficulties from extrinsic compression. Typically, these are diagnosed in childhood but rarely may present in adults. In the presence of symptoms, which require formal gastrointestinal and pulmonary evaluation, surgical resection of the nondominant arch is typically recommended to release the vascular ring. Monitoring of the carotid and subclavian vasculature is performed intraoperatively to ensure distal perfusion is not affected following distal ligation of the arch.