Surgical repair of right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum

Five cases of right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum, with or without Kommerell's diverticulum, are presented. Either right or left thoracotomy with divesion of the aberrant retroesophageal left subclavian artery can be accomplished with good results. However, a right thoracotomy is recommended in the presence of a large Kommerell diverticulum because such a diverticulum should be excised. The development of a subclavian steal syndrome later in life may be prevented by reimplantation of the divided left subclavian artery into the aorta or the left common carotid artery.     

Total arch replacement for right aortic arch with Kommerell diverticulum and aberrant left subclavian artery

A 57-year-old man suspected of having angina pectoris underwent coronary angiography and comprehensive examination, which revealed a right-side aortic arch accompanying Kommerell diverticulum and a aberrant left subclavian artery. Esophagography indicated that the esophagus was compressed on its right posterior side and the computed tomography (CT) revealed that the posterior side of the tracheal was compressed, however, the patient experienced no difficulty in breathing, hoarseness of voice or dysphasia. The size of the aortic diverticulum was less than 5 cm and the patient showed no symptom, however, if it was left untreated, there was a risk of rupture in the future. Also the esophagus and tracheal may develop complications due to prolonged compression. Therefore, we decided that the case required surgical operation. Total arch replacement was performed through mediastinotomy and right posterolateral in the 4th intercostal. The postoperative condition was good, and the patient was discharged without any complications.     

Repair of Kommerell's diverticulum with aberrant left subclavian artery in an elderly patient with right aortic arch and dysphagia lusoria

A 60-year-old femalepresented with progressive dysphagia and was found to have a right-sided aortic arch with external posterior compression of the upper esophagus due to severe compression from a Kommerell's diverticulum with an aberrant left subclavian artery. This patient underwent division of the diverticulum with an aorto-subclavian graft implantation under femoro-femoral bypass and recovered uneventfully. A review of the literature and discussion of the surgical management is presented.     

Congenital subclavian steal syndrome: a case of right aortic arch with atretic aberrant left subclavian artery

Surgical experience of a rare case of congenital subclavian steal syndrome is reported. A 53 year old man was admitted to our hospital complaining of black out attack and headache. Non invasive and angiographic studies revealed the subclavian steal associated with right aortic arch and atretic aberrant left subclavian artery. Through the supraclavicular incision, the direct anastomosis of the left common carotid and subclavian artery was performed. Postoperative angiograms showed a perfect reconstruction of the left subclavian artery and the disappearance of the subclavian steal and about on third amount of the complaints are still remained. Concerning a review of the literatures, several problems are discussed.     

A double aortic arch mimicking a right aortic arch with an aberrant subclavian artery

A 4-month-old boy was referred for persistent respiratory symptoms despite having undergone division of the ligamentum arteriosus for the diagnosis of a right aortic arch with an aberrant left subclavian artery. A computed tomography scan demonstrated symmetric arch vessels around the trachea at the thoracic inlet, with the left common carotid artery being tethered posteriorly, more suggestive of a double aortic arch with an atretic left arch between the left common carotid and subclavian arteries. This diagnosis was confirmed intraoperatively, and division of the atretic portion released the bronchial obstruction. This case highlights the importance of careful evaluation of the vascular anatomy.     

A remnant left aortic arch and a right aortic arch as well as Kommerell's diverticulum with an aberrant left subclavian artery

We report the case of a 63-year-old woman who had dysphagia and dyspnea for one year. Enhanced computed tomography revealed that she had an ascending aortic dorsal projection and a right aortic arch as well as Kommerell's diverticulum (KD) with an aberrant left subclavian artery (LSA). Her KD compressed her trachea and esophagus. We cut her aorta just distal to the KD and performed an ascending and total arch replacement through a midsternotomy. The LSA was reconstructed in front of her trachea. Her dysphagia and dyspnea disappeared following the operation and her postoperative course was uneventful.     

An aberrant left subclavian artery aneurysm with right aortic arch: Report of a case

The case of a 41-year-old man who developed an aneurysm in his aberrant left subclavian artery is described. The patient had a right aortic arch. After a successful aortosubclavian artery bypass, symptoms due to brain ischemia disappeared. This is a very rare disease that is sometimes associated with an aortic anomaly, therefore the optimal therapeutic procedure need to be carefully selected, including the operative indications and approach.     

Surgical treatment of an aneurysm in the right aortic arch with aberrant left subclavian artery

A saccular aneurysm in the right-sided aortic arch with aberrant left subclavian artery is an uncommon disease, and surgical treatment is complicated. Three patients with Edwards type III-B right aortic arch and enlargement of the Kommerell's diverticulum underwent operations. Right thoracotomy was the preferred approach for this lesion and partial cardiopulmonary bypass is a safe and simple procedure when the aortic arch has mild atherosclerosis.     

Right aortic arch with aberrant left subclavian artery: Symptomatic in adulthood

A 42 year old black woman presented initially with symptoms of acute aortic dissection. She subsequently had symptoms of esophageal obstruction that were proved aortographically to be due to right aortic arch with an aberrant left subclavian artery. Relief of the esophageal obstruction was achieved only after dividing the aortic arch posteriorly and freeing the trachea and esophagus from the surrounding structures.     

Undiagnosed aberrant right subclavian artery: pitfall in aortic arch surgery

Selected cerebral perfusion as brain protection via right subclavian artery during aortic arch aneurysm repair adds safety, but may be jeopardized by aortic arch anomalies not readily recognized preoperatively. We describe a case of transverse aortic arch aneurysm repair where an undiagnosed aberrant right subclavian artery was cannulated for selective brain protection.     

Aortic arch reconstruction for interrupted aortic arch using an aberrant right subclavian artery

An aberrant right subclavian artery can be used in a variety of ways in complex aortic arch reconstructions, including reconstruction of an interrupted aortic arch. Here, we described the case of a 4-month-old female infant with a type B interrupted aortic arch, who underwent arch reconstruction using an aberrant right subclavian artery.     

Surgical treatment of aortic arch aneurysm associated with the aberrant right subclavian artery

A 64-year-old man, who had an aneurysm of aortic arch associated with the aberrant right subclavian artery, was treated successfully. He was pointed out to have an aneurysm of aortic arch three years ago. Three years later angiograms and computed tomography revealed that it became larger compared with the initial finding. He underwent a replacement of the aortic arch using a woven Dacron graft under open distal method. Aberrant subclavian artery was not involved in the aneurysm. But because the left subclavian artery was involved in it, a woven Dacron graft was interposed between the ascending aorta and left subclavian artery. Postoperative course was uneventful and there were no complications.