Right aortic arch with isolation of the left subclavian artery and bilateral patent ductus arterioses. A case report.

The surgical management of a case of right aortic arch with isolation of the left subclavian artery and bilateral patent ductus arterioses is described. A review of the 39 cases of isolation of the left subclavian artery reported in the literature revealed only one single case which on autopsy was found to have associated bilateral ductus arterioses. The case we report is the first in which the diagnosis was made during life and successful surgical correction was carried out.     

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.     

Complete correction of interrupted right aortic arch with isolation of left subclavian artery

Isolation of the left subclavian artery is a rare aortic arch anomaly. Association with a right interrupted aortic arch and a double patent ductus arteriosus is exceptional. We report a case of such an association with successful surgical correction.     

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 case of right aortic arch with the stenotic left subclavian artery at its origin complaining of left nuchal pain

A 25 year-old male was transfered to our department with a complaint of left nuchal pain. Angiography revealed a right aortic arch with the stenotic left subclavian artery at its origin and poor left vertebral artery. The anomaly was classified an intermediate type of Stewart type (2) and (3). It was very rare and we have found only 3 same cases in literature. The complaint disappeared after the ascending aorto-left subclavian artery bypass.     

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.     

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.     

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

A case of right aortic arch with an aberrant left subclavian artery arising from a Kommerell's diverticulum of the descending thoracic aorta with a left ligamentum arteriosum completing a vascular ring about the trachea and esophagus is presented. A posterolateral left thoracotomy alone is sufficient to provide an excellent exposure for the division of the ligamentum arteriosum and the resection of the Kommerell's diverticulum. Furthermore, the development of a subclavian steal syndrome is prevented by the reimplantation of the divided left subclavian artery into the left common carotid artery through this same incision.     

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.     

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.     

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.     

Coarctation of aorta with right aortic arch and anomalous left subclavian artery]

The occurrence of coarctation in patients with right aortic arch is extremely rare. We have encountered a 21-year-old man with anomalous left subclavian artery. He was diagnosed when he was 13. On angiography he exhibited a right aortic arch. The left common carotid artery, right common carotid artery and the right subclavian artery diverged from the proximal side of the coarctation. The left subclavian artery diverged from the distal side. The right brachial arterial pressures measured 158-72 mmHg, while the left brachial arterial pressures measured 98-80 mmHg. Clinical studies revealed no vascular ring and no other anomalies were found in this patient. An attempt at treatment was made with extra anatomical bypass grafting from the ascending aorta to the descending aorta. No pressure difference due to coarctation remained after operation.