A 55-year-old male was referred by his general practitioner due to mild complaints of shortness of breath (no angina) upon exertion. He used to work as a gym teacher at a secondary school and currently exercises intensively for up to 10 h a week. His father died suddenly at the age of 52 years while cross-country skiing. No autopsy was performed. The patient is being treated with perindopril 2 mg once a day due to hypertension and has a blood pressure of 140/90 mm Hg and a resting peripheral O2 saturation of 97% when breathing room air. Electrocardiography showed sinus rhythm with normal de- and repolarisation and a physical examination did not reveal any abnormalities. Transthoracic echocardiography showed normal biventricular and valvular function. Chest radiography revealed an abnormality and prompted further investigation by computed tomography (Fig. 1a–c).
What is the most likely diagnosis?
Acute aortic syndrome
Persistent left superior vena cava
Right-sided aortic arch with an aberrant left subclavian artery
Double aortic arch
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