A Maine Coon kitten was diagnosed with persistent right aortic arch and concurrent mitral and tricuspid valve insufficiency. Diuretic and positive inotropic treatment were administered before surgical treatment was attempted. Surgical ligation of the ligamentum arteriosum was performed successfully. Regurgitation did not resolve despite efforts to slowly introduce solid food to the diet over a period of two months. The kitten suffered from several incidences of aspiration pneumonia that responded to antibiotic treatment. Follow-up computed tomography ruled-out extraluminal constriction of the oesophagus, and oesophagoscopy confirmed a residual megaoesophagus six months post-operatively. The kitten was euthanised seven months after surgery. The importance of a complete cardiac work-up and oesophagoscopy in suspected vascular ring anomaly examinations are highlighted in this case study.