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IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY

Right Aortic Arch and Aberrant Left Subclavian Artery

Velit Halit, MD, Erkan Iriz, MD, Rana Olgunturk, MD1, Serdar Kula, MD1, Fatma Sedef Tunaoglu, MD1

Department of Cardiovascular Surgery
1 Department of Pediatric Cardiology, Gazi University School of Medicine, Ankara, Turkey

Erkan Iriz, MD, Tel: +90 312 2025619/2025637, Fax: +90 312 2129014, Email: erkaniriz{at}hotmail.com, Gazi Üniversitesi Tip Fakültesi Kalp ve Damar Cerrahisi AD, Besevler 06500, Ankara, Turkey.

The esophagogram (Figure 1Go) shows compression of the proximal 3rd of the esophagus from both sides in a 15-month-old boy who presented with dysphagia lusoria and respiratory distress. He had been followed up at another hospital with a diagnosis of right aortic arch and abnormal arch branching. He had undergone 2 operations: a right lower lobectomy for bronchiectasis at 3-months old, and an attempt to approach the aberrant left subclavian artery via a sternotomy, which proved impossible. Echocardiography showed an aortic arch abnormality, right aortic arch, and aberrant left subclavian artery. Successful surgical correction was carried out via a left 4th intercostal lateral thoracotomy. The left subclavian artery and descending aorta were mobilized, the aberrant left subclavian artery was ligated, and the segment between the proximal subclavian artery and its branches was resected. The post operative period was uneventfull and discharged on 12th day after the operation.


Figure 1
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  		Figure 1. The oesophagogram shows a compression to the 1/3 proksimal oesophagus.

 
As can be seen in the aortic arch angiogram in right anterior oblique view (Figure 2Go), the right aortic arch and aberrant left subclavian artery arose from the descending aorta and passed along the vascular trace before ascending behind the esophagus and crossing it anteriorly. In conclusion, surgery in patients with right aortic arch and aberrant left subclavian artery should be performed via a left posterolateral thoracotomy because mobilization of the artery and esophagus can be performed easily by this approach.


Figure 2
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  		Figure 2. Aortic arch angiogram with right anterior oblique position shows an aberrant left subclavian artery that arising from the descending aorta.

 

REFERENCES

  1. Drucker MH, Symbas PN. Right aortic arch with aberrant left subclavian artery: symptomatic in adulthood. Am J Surg 1980;139:432–5.[Medline]

  2. Yap J, Hayward PA, Lincoln C. Right aortic arch with aberrant subclavian arteries: a cause of esophageal compression. Ann Thorac Surg 1999;68:2331–2.[Abstract/Free Full Text]

Asian Cardiovasc Thorac Ann 2009; 17:214-215
© 2009 by SAGE Publications
DOI: 10.1177/0218492309103334



This Article
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Velit Halit
Erkan Iriz
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Right arrow Articles by Tunaoglu, F. S.

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