IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Asymptomatic Vascular Rings of Aorta in Adult Cardiac Surgery Patients
Kenji Minakata, MD,
Tomoyuki Yunoki, MD,
Yosuke Sakai, MD1,
Kazuaki Kataoka, MD1,
Keiji Ujino, MD1
Division of Cardiovascular Surgery
1 Division of Cardiovascular Medicine Tominaga Hospital, Osaka, Japan
Kenji Minakata, MD, Tel/Fax: +81 6 6568 1601/8, Email: k_minakata{at}hotmail.com, 1-4-48 Minatomachi Naniwa-ku Osaka-city, 556-0017, Japan.
A 70-year-old man presented with recurrent exertional chest oppression. His history included insulin-dependent diabetes, systemic hypertension, hypercholesterolemia, minor stroke, and myocardial infarction with a subsequent percutaneous catheter intervention. Coronary angiography showed severe 3-vessel disease with significant left main stenosis. A double aortic arch was identified incidentally by multidetector computed tomography (Figure 1
). Both arches arose from the ascending aorta, gave rise to the common carotid and subclavian arteries, encircled the trachea and esophagus, and joined the descending aorta. The distal ascending aorta and both aortic arches were heavily calcified. There were no respiratory symptoms or dysphagia. Successful off-pump triple coronary artery bypass was carried out by anastomosis of the left internal thoracic artery to the left anterior descending artery and 2 separate vein grafts to the right posterior descending artery and first diagonal branch.
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Figure 1. Multidetector computed tomography demonstrating double aortic arch. The aortic arches were balanced and gave rise to the common carotid and subclavian arteries on each side.
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A man aged 76 years presented with exertional dyspnea and chest pressure. Echocardiography demonstrated severe bicuspid aortic valve stenosis and moderate mitral regurgitation. His ejection fraction was preserved at 62% with concentric severe left ventricular hypertrophy. Multidetector computed tomography of the chest showed diffuse dilation of the ascending aorta and proximal arch to 50–55 mm in diameter. The right subclavian artery was found to arise from the distal aortic arch and pass behind the trachea and esophagus (Figure 2). The patient denied dysphagia. He underwent aortic and mitral valve replacements and graft replacement of the ascending aorta, which completely relived his symptoms.
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Figure 2. Aberrant right subclavian artery arising from the distal aortic arch and passing behind the trachea.
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Asian Cardiovasc Thorac Ann 2009;
17:531-532
© 2009 by SAGE Publications
DOI: 10.1177/0218492309348625
