Right Aortic Arch and Esophageal Atresia: Understanding the Anatomy and Approach

Right aortic arch (RAA) and other vascular aberrations occurring in association with esophageal atresia complicate the surgical repair and outcome. It is very important to understand the anatomy and recognize it intraoperatively. Preoperative recognition is difficult for these anomalies. Clues to making a pre-op diagnosis are presented; this will help the surgeon to make a clear plan for the side of the approach. The right arch presents a technical challenge for esophageal dissection and anastomosis. There is speculation over the side of approach for repair. This chapter deliberates over the anatomy and recognition and provides a decision-making flow chart for the left- or right-side approaches for the best outcome. The video clips included show the live anatomy and surgical repair done in a case of esophageal atresia with right aortic arch with right thoracoscopy. A brief review of the available literature on RAA and esophageal atresia with tracheo-esophageal fistula (EA-TEF) is also discussed. Vascular aberrations other than RAA which are very rare are also outlined.