Aneurysms of an aberrant right subclavian artery: report of two cases

Aneurysm of the aberrant right subclavian artery is rare. We report two patients who underwent successful repair using hypothermic circulatory arrest and retrograde cerebral perfusion. One patient presented with progressive dysphagia to solids and hoarseness of voice due to pressure exerted by the expanding aneurysm, and the second patient, with a dissected subclavian aneurysm, presented with transient ischaemic attacks and a previous cerebral infarct secondary to embolism. Repair in both patients was done through a median sternotomy with femoral arterial and right atrial venous cannulation. Under hypothermic circulatory arrest, the origin of the subclavian aneurysm was divided off the aorta and closed with a Dacron patch from outside the aorta in one patient, and from within the aorta in the other patient. Concomitant revascularisation of the right upper limb was achieved using a 12-mm Hemishield Dacron graft from the ascending aorta to the distal right subclavian artery. The graft to subclavian anastomosis was done under hypothermic circulatory arrest as distal control was not possible. The graft to the aortic anastomosis was done over a side-biting clamp during rewarming. Both patients were successfully treated without major morbidity.     

Isolated right subclavian artery arising from the right pulmonary artery via a right-sided ductus arteriosus with associated pulmonary steal phenomenon

We present a patient with DiGeorge syndrome and an isolated right subclavian artery arising from the right pulmonary artery via a right-sided ductus arteriosus. The patient showed a subclavian and pulmonary steal with perfusion of the right arm and right lung via retrograde circulation in the right vertebral artery. The patient underwent successful surgical repair.     

Successful transcatheter coil occlusion of a right-sided patent ductus arteriosus with aberrant left subclavian artery

Right aortic arch is a relatively rare congenital anomaly. The combination of a right aortic arch, a right patent ductus arteriosus, and an aberrant left subclavian artery in a child with an otherwise structurally normal heart is very uncommon. We report the successful transcatheter coil occlusion of a right-sided patent ductus arteriosus in a child with the above-mentioned anatomy. To our knowledge, such a case has not been reported in the English-language medical literature to date.     

动脉导管未闭介入治疗后肺动脉压改变的研究

目的：探讨动脉导管未闭（PDA）患者介入封堵治疗后肺动脉压改变的影响因素。方法：回顾性分析2008年1月至2011年9月在我院行介入封堵治疗的43例PDA患者的临床及介入手术资料。结果：与治疗前比较,PDA患者介入封堵治疗后肺动脉收缩压[PASP,（76±51）mmHg比（46.26±17.26）mmHg]、肺动脉舒张压[PADP,（39.47±17.11）mmHg比（15.84±10.74）mmHg]、平均肺动脉压[MPAP,（54.72±19.21）mmHg比（28.53±14.41）mmHg]均显著降低（P均=0.0001）,PADP下降程度比PASP更明显[（0.54±0.38）比（0.38±0.15）,P=0.012];PDA患者介入治疗后PASP、MPAP下降程度与年龄呈负相关（B=-0.04,P=0.012;B=-0.006,P=0.009）;术后MPAP下降程度与动脉导管管径呈正相关（B=0.022,P=0.01）。结论：介入封堵治疗对动脉导管未闭有益,应在年龄较小时尽早手术。     

Aberrant patent ductus arteriosus associated with double brachiocephalic trunk and interrupted left subclavian artery

Although patent ductus arteriosus (PDA) is the most common type of extracardiac shunt, aberrant PDA associated with other cardiac malformations as double brachiocephalic trunk and interrupted left subclavian artery is extremely rare. To the best of our knowledge, the literature contains no other report of a patient who has PDA originated from left subclavian artery associated with ventricular septal defect (VSD), double brachiocephalic trunk and interrupted left subclavian artery.     

Dissected aberrant right subclavian artery with Kommerell diverticulum

Aberrant right subclavian artery is the most frequent anomaly of the aortic arch, and in 60% of cases is associated with Kommerell diverticulum. It is usually asymptomatic but may present with dysphagia or asthma due to esophageal and tracheal compression. Indications for surgical repair have not been established; however, when Kommerell diverticulum is complicated by aortic dissection the treatment is surgery. We present the case of a 54-year-old man with thoracic pain due to dissection of an aberrant right subclavian artery associated with Kommerell diverticulum. Elective surgical treatment was performed.     

巨大动脉导管未闭的封堵治疗

目的 评价应用国产封堵器封堵治疗巨大动脉导管未闭（PDA）的疗效.方法 全组17例,男性8例,女性9例,年龄15～43（24.5±11.1）岁.主动脉造影示PDA最窄腰部内径为18～26（25.5±1.8）mm,需采用腰部直径20mm以上的封堵器方可操作成功.术后3d及3个月后复查超声心动图.结果 术前超声诊断,17例中6例合并重度肺动脉高压,17例患者中14例（其中5例合并重度肺动脉高压）封堵成功（操作和临床成功）,成功率为82％（14/17）.16例选用国产特制PDA封堵器,1例26 mm ASD因封堵器位置不能牢固地“站稳”而放弃封堵治疗;1例严重肺动脉高压且左向右分流为主存在少量右向左分流,经封堵试验为阻力性肺动脉高压不适宜治疗;1例术后第2天发生封堵器脱落入降主动脉,经捕获器成功取出体外,但死于误吸（迷走反射引起恶心呕吐）导致的严重肺部感染及感染性休克.封堵成功14例,封堵器直径为22～30（26.5±2.7）mm,术后即刻降主动脉造影检查示9例微量残余分流,均为封堵器中间存在云雾状分流,10 min后重复造影云雾状分流消失.术后3d及术后3个月超声心动图示患者所有左心内径增大均明显回缩,未发现残余分流和导管再通.结论 巨大PDA在可能的范围内尽量争取介入治疗,成功后较普通PDA血液动力学恢复更明显,可获得较好的收益/风险比.     

Repair of left subclavian artery and aberrant right subclavian artery aneurysms

Left subclavian artery aneurysm with an aneurysm of the aberrant right subclavian artery is a rare condition with a reported incidence of 0.13% to 1%. We report the successful surgical correction of both conditions in a 34-year-old man.     

国产蘑菇伞型封堵器封堵巨大动脉导管未闭的可行性研究

目的探讨采用国产蘑菇伞型封堵器经导管封堵巨大动脉导管未闭(PDA)的可行性。方法全组15例,其中男3例,女12例,年龄21±8(16～46)岁。PDA最窄处直径为16±3mm(13～22mm),均采用国产蘑菇伞型封堵器经股静脉途径对PDA进行封堵。封堵前后行主动脉弓降部造影并测定肺动脉压力。封堵成功者分别于术后1周、1个月和6个月复查超声心动图。结果15例巨大PDA选用的封堵器直径为23±4mm(18～32mm),封堵后30min主动脉弓降部造影均显示主-肺动脉水平仅有经封堵器孔眼的微量到少量残余分流。封堵后13例患者肺动脉收缩压峰值较封堵前有不同程度下降(70±29mmHgvs113±21mmHg,P<0.05,1mmHg=0.133kPa),2例因试封堵后肺动脉压力升高而放弃封堵。无一例发生严重并发症。封堵成功者术后复查超声心动图,其中11例于术后1周、1例于术后1个月残余分流消失,另1例于术后6个月时残存少量分流。结论采用国产蘑菇伞型封堵器经导管封堵巨大PDA是一种安全有效的介入治疗方法。     

法洛四联症合并罕见孤立性右锁骨下动脉及双侧动脉导管1例

孤立性锁骨下动脉为十分罕见的先天性主动脉弓畸形,孤立性右锁骨下动脉更为罕见,临床上极易出现漏诊,导致外科术后残留大量左向右分流,使患者恢复困难。术前积极明确诊断,对于外科治疗方案的制定和术后恢复都有着重要的意义。本文报道1例法洛四联症合并孤立性右锁骨下动脉的患儿。该患儿在术前、术中出现漏诊,术后通过心导管检查明确诊断,进行介入治疗后恢复良好。     

Three cases of esophageal cancer with aberrant right subclavian artery treated by thoracoscopic esophagectomy

An aberrant right subclavian artery (ARSA) is an anatomical abnormality that occurs at a frequency of 0.4–2 %. It is important to be aware of this abnormality when performing radical esophagectomy for esophageal cancer because many patients with an ARSA have a right nonrecurrent inferior laryngeal nerve (NRILN) and right thoracic duct. We report three cases of esophageal cancer with ARSA treated by thoracoscopic esophagectomy. Case 1 was a 59-year-old woman with a relapse of a thoracic esophageal cancer after definitive chemoradiotherapy (CRT). Case 2 was a 76-year-old man with upper thoracic esophageal cancer who had received no treatment before the surgery. Case 3 was a 69-year-old man with upper thoracic esophageal cancer pretreated with neoadjuvant CRT. It was possible to predict an ARSA by computed tomography and the right thoracic ducts by magnetic resonance imaging before surgery in all three cases. Thoracoscopic esophagectomy with two-field lymph node dissection was performed, and the NRILN and the right thoracic duct were detected and preserved in all three cases. Because of ARSA, the operative field is limited around the left recurrent nerve, so a careful procedure is needed to avoid nerve palsy.     

Patent ductus arteriosus closure using a new device: the Nit-Occlud device

Between May 2003 and July 2006, we carried out percutaneous patent ductus arteriosus closure using a Nit-Occlud device in 28 patients, who had a median age of 1.8 years (range 0.5-21 years) and a median weight of 10.9 kg (range 5.9-64 kg). The ductus arteriosus had several different morphologic forms, and there was one postsurgical recanalization of the ductus arteriosus. The median minimum ductal diameter was 1.8 mm and the median maximum aortic ampulla diameter was 6.5 mm. The occlusion rate immediately after intervention was 53.5%, which increased to 95.2% by 12 months and to 100% by 18 months. The median follow-up time was 20.5 months. The Nit-Occlud device provided an effective and safe means of patent ductus arteriosus closure, irrespective of ductus morphology.