Infants with a double aortic arch most commonly present with which of the following problems?

b. High output cardiac failure related to a patent ductus arteriosus

The double aortic arch represents the most common type of complete vascular ring. It arises from the ascending aorta and bifurcates, with one arch passing on either side of the trachea and the esophagus. The symptoms of complete vascular rings are due to compression of the trachea, the esophagus or both. The child with a double aortic arch is generally the most symptomatic and most patients have symptoms in infancy. The typical clinical picture is one of symptomatic tracheal compression and includes inspiratory wheezing, coughing, noisy breathing, shortness of breath, stridor and frequent bouts of pneumonia. Feeding problems may become apparent when solid foods are started but this is less common than tracheal compression. The most important screening test is the barium swallow, and CT or MRI are definitive. Angiography and endoscopy are not usually helpful. Any patient who is symptomatic from a vascular ring should be treated surgically.