Abstract
BACKGROUND: Double aortic arches are rare congenital heart defects, representing <1% of congenital heart defects; most double aortic arches form a vascular ring wrapping around the trachea and esophagus. This finding typically presents in childhood with symptoms like dyspnea, stridor, and recurrent respiratory infections. Adults less commonly present with this condition; however, when they do, respiratory and gastrointestinal symptoms may be present. CASE SUMMARY: We present a case of a 38-year-old woman who was evaluated for dyspnea and chest pain in the emergency department, and incidentally found to have a right-dominant double aortic arch, persistent left superior vena cava, and coronary artery anomaly. DISCUSSION: The presence of these cardiac vascular anomalies is an exceptionally rare combination not previously reported together. Approaches to initial work-up and future follow-up is addressed. TAKE-HOME MESSAGE: Awareness of these anomalies is critical because they can have major implications regarding future interventions, like catheter-based procedures and surgical planning.