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Axt-Fliedner R, Nazar A, Bedei I, Schenk J, Reitz M, Rupp S, Jux C, Wolter A. Associated Anomalies and Outcome in Patients with Prenatal Diagnosis of Aortic Arch Anomalies as Aberrant Right Subclavian Artery, Right Aortic Arch and Double Aortic Arch. Diagnostics (Basel) 2024; 14:238. [PMID: 38337754 PMCID: PMC10855084 DOI: 10.3390/diagnostics14030238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
We aimed to evaluate retrospectively associated anomalies and outcome in prenatal aortic arch anomalies (AAAs). We included ninety patients with aberrant right subclavian artery (ARSA), right aortic arch (RAA) with mirror image branching (RAA-mirror) or aberrant left subclavian artery (RAA-ALSA) and double aortic arch (DAA) between 2011 and 2020. In total, 19/90 (21.1%) had chromosomal anomalies, the highest rate being within the ARSA subgroup (17/46, 37%). All (13/13) of the RAA-mirror subgroup, 10/27 (37.0%) of RAA-ALSA, 13/46 (28.3%) of ARSA and 0/4 within the DAA subgroup had additional intracardiac anomaly. The rate of extracardiac anomalies was 30.7% in RAA-mirror, 28.3% in ARSA, 25.0% in DAA and 22.2% in the RAA-ALSA subgroup. A total of 42/90 (46.7%) had isolated AAAs: three (7.1%) with chromosomal anomalies, all trisomy 21 (3/26, 11.5%) within the ARSA subgroup. Out of 90, 19 (21.1%) were lost to follow-up (FU). Two (2.2%) intrauterine deaths occurred, and six (6.7%) with chromosomal anomalies terminated their pregnancy. In total, 63 (70.0%) were liveborn, 3/63 (4.8%) with severe comorbidity had compassionate care and 3/60 (5.0%) were lost to FU. The survival rate in the intention-to-treat cohort was 53/57 (93%). Forty-one (77.4%) presented with vascular ring/sling, two (4.9%) with RAA-ALSA developed symptoms and one (2.4%) needed an operation. We conclude that intervention due to vascular ring is rarely necessary. NIPT could be useful in isolated ARSA cases without higher a priori risk for trisomy 21 and after exclusion of other anomalies.
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Affiliation(s)
- Roland Axt-Fliedner
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Asia Nazar
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Ivonne Bedei
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Johanna Schenk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Maleen Reitz
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Stefan Rupp
- Department of Paediatric Cardiology, Children’s Hospital, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (S.R.); (C.J.)
| | - Christian Jux
- Department of Paediatric Cardiology, Children’s Hospital, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (S.R.); (C.J.)
| | - Aline Wolter
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
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Nasser M, Petrocheli BB, Felippe TKS, Isola B, dos Santos Pereira BC, Sartoreli ALC, Batista JM, Brandão GMS. Aberrant right subclavian artery: case report and literature review. J Vasc Bras 2023; 22:e20210151. [PMID: 36855544 PMCID: PMC9968513 DOI: 10.1590/1677-5449.202101512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/17/2022] [Indexed: 02/22/2023] Open
Abstract
The aberrant right subclavian artery, also known as the arteria lusoria, is the most common aortic arch anomaly, occurring in 0.5 to 1% of the population. There is a higher prevalence in women and it is usually associated with other anatomical variations, such as the non-recurrent laryngeal nerve, present in 86.7% of cases. In the majority of cases, the aberrant right subclavian artery causes no symptoms. We describe this anomaly in an 82-year-old, hypertensive, and asymptomatic patient who had undergone a thoracoabdominal angiography to investigate a chronic DeBakey type III aortic dissection with dilation of the descending aorta. The aberrant right subclavian artery followed a retroesophageal course and was associated with a Kommerell diverticulum. In view of its rarity, we conducted an integrative bibliographic review of literature from the last 6 years indexed on the Medline, UpToDate, Lilacs, Scielo, and Portal Capes databases and discuss the most frequent anatomical changes, symptomatology, and therapeutic management adopted.
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Affiliation(s)
- Michel Nasser
- Universidade Federal de São Carlos - UFSCar, Departamento de Medicina, São Carlos, SP, Brasil.
| | | | | | - Beatriz Isola
- Universidade Federal de São Carlos - UFSCar, Departamento de Medicina, São Carlos, SP, Brasil.
| | | | | | - João Marques Batista
- Universidade Federal de São Carlos - UFSCar, Departamento de Medicina, São Carlos, SP, Brasil.
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Nasser M, Petrocheli BB, Felippe TKS, Isola B, Pereira BCDS, Sartoreli ALC, Batista Junior JM, Brandão GMS. Artéria subclávia direita aberrante: relato de caso e revisão de literatura. J Vasc Bras 2023. [DOI: 10.1590/1677-5449.202101511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Resumo A artéria subclávia direita aberrante, também conhecida como artéria lusória, é a anomalia do arco aórtico mais comum, ocorrendo entre 0,5 e 1% da população. Possui prevalência em mulheres e normalmente está associada a outras variações anatômicas, como o nervo laríngeo não recorrente, presente em 86,7% dos casos. Em sua maioria, a artéria subclávia direita aberrante não apresenta sintomas. Descrevemos essa alteração em uma paciente de 82 anos, hipertensa e assintomática, que havia sido submetida a uma angiotomografia toracoabdominal para a avaliação de uma dissecção crônica tipo III (DeBakey) associada à dilatação de aorta descendente. No achado, a artéria subclávia direita aberrante apresentava percurso retroesofágico associado a um divertículo de Kommerell. Devido à raridade, realizamos revisão bibliográfica integrativa das bases de dados MEDLINE, UpToDate, LILACS, SciELO e Portal CAPES dos últimos 6 anos e discutimos as alterações anatômicas mais frequentes, a sintomatologia e as condutas terapêuticas adotadas.
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Hussain A, Yiu AC, Okonkwo UA. Aneurysmal Aberrant Right Subclavian Artery in an Active Duty U.S. Military Male (Case Report). Mil Med 2021; 187:e539-e542. [PMID: 33570147 DOI: 10.1093/milmed/usab049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/11/2020] [Accepted: 02/01/2021] [Indexed: 11/14/2022] Open
Abstract
We present a rare case of four-vessel aortic arch with an aneurysmal aberrant right retro-esophageal subclavian artery (ARSA) in a healthy, asymptomatic active duty U.S. military male. ARSA has a prevalence of 0.6%-1.4%, of which ∼80%-84% are retro-esophageal ARSAs. Intrathoracic subclavian artery aneurysms are rare and often occur in association with congenital aortic arch anomalies and/or concomitant thoracic aortic pathology. This case adds to three previously documented cases of thoracic aortic disease (TAD) in the U.S. military and is the second documented case of ARSA in the U.S. military. This case highlights successful TAD identification in a service member before clinical decompensation.
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Affiliation(s)
- Ali Hussain
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI 96859-500, USA
| | - Alvin C Yiu
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI 96859-500, USA
| | - Uzoagu A Okonkwo
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI 96859-500, USA
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Akbar H, Kahloon A, Kahloon R. Diagnostic Challenge in a Symptomatic Patient of Arteria Lusoria with Retro-esophageal Right Subclavian Artery and Absent Brachiocephalic Trunk. Cureus 2020; 12:e7029. [PMID: 32117665 PMCID: PMC7029822 DOI: 10.7759/cureus.7029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A combination of absent brachiocepahlic trunk and anomalous left circumflex artery with a retro-esophageal right subclavian artery is an extremely rare finding. This can clinically manifest as episodic dysphagia and chest pain. Routine coronary angiography via femoral access could be misleading and right radial access in such cases can be particularly challenging and has never been reported in literature before. We present a case of a 42-year-old female with symptoms of chest, back, and left neck pain. She also complained of occasional dysphagia, dizziness, and palpitations. Physical examination revealed a regular heart rhythm with no vascular bruits. An electrocardiogram (EKG) only showed normal sinus rhythm and incomplete right bundle branch block. Noninvasive testing included an echocardiogram and previously done exercise stress test, and myocardial perfusion scans were noted to be normal. A diagnostic cardiac catheterization via right radial approach was performed to delineate her coronary anatomy and rule out ischemic etiology. This led to diagnosis of anomalous coronary anatomy (retro-esophageal right subclavian artery arising from descending aorta in association with an anomalous right circumflex artery with absent innominate artery) through a technically difficult and risky procedure. Significant vessel tortuosity and abnormal catheter angulations were encountered and were overcome by using specific catheters. Meticulous use of 6 French MP, WR, JL, and JR4 catheters along with an exchange length wire was required to negotiate the anatomical variations and complete the coronary angiogram via right radial artery. From a procedural stand-point, coronary angiography via right radial access in presence of such rare anatomical variations can be particularly challenging. Routine femoral catheterization may fail to depict this important anatomical variation. Coronary angiogram via right radial access in the presence of a combination of anatomical variations of great vessels and anomalous coronary arteries is particularly challenging from a procedural stand point due to vessel tortuosity and shape of catheters. Choice of anatomically appropriate diagnostic catheters and specific maneuvers are imperative in these coronary angiographic procedures.
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Affiliation(s)
- Hina Akbar
- Internal Medicine and Hospital Medicine, The University of Tennessee Health Science Center (UTHSC), Memphis, USA
| | - Arslan Kahloon
- Gastroenterology, Erlanger Health System/UT College of Medicine, Chattanooga, USA
| | - Rehan Kahloon
- Cardiology, Erlanger Health System/UT College of Medicine, Chattanooga, USA
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Mittal S, Sharma A, Dixit S, Sharma M. Kommerell diverticulum with right-sided aortic arch with aberrant left subclavian artery. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_91_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Three Rare Structural Anomalies: Right Aberrant Subclavian Artery, Kommerell's Diverticulum, and Isolated Left Vertebral Artery All Associated with Type B Aortic Dissection. Case Rep Surg 2019; 2019:7927613. [PMID: 31007962 PMCID: PMC6441505 DOI: 10.1155/2019/7927613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/27/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction and Background Right aberrant subclavian artery accounts for 0.5-1.8% of the population as the most frequently encountered aortic arch anomaly, while the prevalence of an isolated left vertebral artery ranges from 3 to 8%. Despite the low prevalence and the asymptomatic presentation of these structural anomalies, the development of cardiovascular complications and aneurysmal formation could happen as in Kommerell's diverticulum in a complicated right aberrant subclavian artery, which can undergo aneurysmal degeneration and dissection. Depending on the severity and the degree of the symptoms, the management of the patient can be determined. Case Presentation A 51-year-old male hypertensive Pakistani patient was admitted complaining of chest and back pain; a CT of the aorta was done and showed type B aortic dissection associated with a right aberrant subclavian artery with an isolated left vertebral artery. A thoracic endovascular aneurysmal repair was done, and the patient improved afterward. Conclusion The prevalence of these structural anomalies, the right aberrant subclavian artery, Kommerell's diverticulum, and isolated left vertebral artery with type B aortic dissection, is uncommon. Therefore, the earlier the diagnosis, the better the treatment. This is the first case report explaining the occurrence of these vascular anomalies together in Saudi Arabia.
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Silveira JV, Junqueira FP, Silveira CG, Consolim-Colombo FM. Kommerell Diverticulum: Right Aortic Arch with Anomalous Origin of Left Subclavian Artery and Duplicity of Right Vertebral Artery in a 16-Year-Old Girl. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:228-232. [PMID: 30787266 PMCID: PMC6394145 DOI: 10.12659/ajcr.912053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patient: Female, 16 Final Diagnosis: Kommerell diverticulum Symptoms: Tachycardia Medication: — Clinical Procedure: Clinical observation only Specialty: Cardiology
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Affiliation(s)
- João V Silveira
- Departmet of Medicine, Universidade Nove de Julho, São Paulo, SP, Brazil
| | | | - Cylmara G Silveira
- Departmet of Pediatrics, Universidade Nove de Julho, São Paulo, SP, Brazil
| | - Fernanda M Consolim-Colombo
- Departmet of Catdiology, Universidade Nove de Julho, São Paulo, SP, Brazil.,Departmet of Cardiology, Instituto do Coração, Universidade de São Paulo Brazil (InCor) 3, São Paulo, SP, Brazil
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Lam NH, Van Ngoc T, Vu LT. Aberrant right subclavian artery and bibasilar bronchiectasis: is there any association? Respir Med Case Rep 2019; 27:100844. [PMID: 31061787 PMCID: PMC6487362 DOI: 10.1016/j.rmcr.2019.100844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/13/2019] [Accepted: 04/13/2019] [Indexed: 11/28/2022] Open
Abstract
Dysphagia is the most common symptom in symptomatic patients with aberrant right subclavian artery (ARSA) and also the risk factor of aspiration, especially in elderly patients. We presented an 84 year-old female patient with dysphagia induced by the compression of ARSA to the adjacent structures. Recurrent pneumonia and bibasilar bronchiectasis were recorded in the association with ARSA. We concluded that elderly patient with ARSA should be evaluated the pulmonary complications such as aspiration pneumonia and bronchiectasis.
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Affiliation(s)
- Nguyen Ho Lam
- Corresponding author. Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217, Hong Bang, Ward 11, District 5, Ho Chi Minh City, Viet Nam.
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Menon RS, Muetterties C, Moser GW, Wheatley GH. Endoanchor stenting for the repair of a Type I endoleak in the aortic arch following the endovascular repair of a Kommerrell's diverticulum. J Card Surg 2016; 31:541-3. [DOI: 10.1111/jocs.12793] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rohan S. Menon
- Howard University, College of Medicine; Washington District of Columbia
| | - Corbin Muetterties
- Division of Cardiovascular Surgery; Temple University School of Medicine; Philadelphia Pennsylvania
| | - George William Moser
- Division of Cardiovascular Surgery; Temple University School of Medicine; Philadelphia Pennsylvania
| | - Grayson H. Wheatley
- Division of Cardiovascular Surgery; Temple University School of Medicine; Philadelphia Pennsylvania
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Komooka M, Higashiue S, Kuroyanagi S, Furuya O, Naito S, Kojima S. Hybrid endovascular repair for an arch aneurysm combined with aberrant right subclavian artery. Ann Vasc Dis 2015; 8:59-61. [PMID: 25848437 DOI: 10.3400/avd.cr.14-00123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/16/2015] [Indexed: 11/13/2022] Open
Abstract
This report describes a hybrid endovascular approach to a 9.3-cm saccular aneurysm of the left sided aortic arch combined with an aberrant right subclavian artery. The two-step procedure consisted of a bilateral carotid-subclavian bypass, followed by an ascending aorta-bicarotid bypass and completed by an endovascular exclusion of the aneurysm by covering the whole aortic arch and its branches. The patient had no postoperative complications and was discharged 10 postoperative day. Hybrid procedures may be useful in complex aortic arch pathologies and may reduce postoperative complications in comparison with conventional open surgery.
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Affiliation(s)
- Masatoshi Komooka
- Department of cardiovascular surgery, Kishiwada Tokusyukai Hospital, Kishiwada, Osaka, Japan
| | - Shinichi Higashiue
- Department of cardiovascular surgery, Kishiwada Tokusyukai Hospital, Kishiwada, Osaka, Japan
| | - Satoshi Kuroyanagi
- Department of cardiovascular surgery, Kishiwada Tokusyukai Hospital, Kishiwada, Osaka, Japan
| | - Onichi Furuya
- Department of cardiovascular surgery, Kishiwada Tokusyukai Hospital, Kishiwada, Osaka, Japan
| | - Shiho Naito
- Department of cardiovascular surgery, Kishiwada Tokusyukai Hospital, Kishiwada, Osaka, Japan
| | - Saburo Kojima
- Department of cardiovascular surgery, Kishiwada Tokusyukai Hospital, Kishiwada, Osaka, Japan
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Lv P, Lin J, Zhang W, Hu J. Computed tomography findings of Kommerell diverticulum. Can Assoc Radiol J 2014; 65:321-6. [PMID: 25224668 DOI: 10.1016/j.carj.2014.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/12/2014] [Accepted: 05/15/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Peng Lv
- Department of Radiology, Zhongshan Hospital, Fudan University/Shanghai Institute of Medical Imaging/Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University/Shanghai Institute of Medical Imaging/Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai.
| | - Weisheng Zhang
- Department of Radiology, Zhongshan Hospital, Fudan University/Shanghai Institute of Medical Imaging/Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai
| | - Jialu Hu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai
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Bhandary SP, Papadimos TJ, Svensson LG, Sale S. Anesthetic management of the resection of a Kommerell's diverticulum. J Cardiothorac Vasc Anesth 2013; 29:142-5. [PMID: 24332920 DOI: 10.1053/j.jvca.2013.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Sujatha P Bhandary
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH.
| | - Thomas J Papadimos
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH
| | - Shiva Sale
- Department of Anesthesiology, Cleveland Clinic, Cleveland, OH
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Cohen R, Loarte P, Garcia C, Diaz L, Mirrer B. Syncope as initial presentation of kommerell diverticulum. Int J Angiol 2013; 21:111-6. [PMID: 23730141 DOI: 10.1055/s-0032-1315629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Kommerell diverticulum (KD) is an aortic arch diverticulum at the origin of an aberrant subclavian artery. It is a rare anatomical anomaly that can be associated with a double aortic arc, a left aortic arch, and anomalous origin of the right subclavian artery or a right aortic arch with anomalous left subclavian artery. We present a case of KD presenting initially as syncope, as well as a review of the literature of this rare syndrome, including diagnosis, imaging techniques, and current surgical treatments.
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Affiliation(s)
- Ronny Cohen
- Division of Cardiology, Department of Medicine, NYU School of Medicine, Brooklyn, New York ; Division of Cardiology, Department of Medicine, Woodhull Medical Center, Brooklyn, New York
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Kommerell's Diverticulum: An Unusual Cause of Chronic Cough. Case Rep Pulmonol 2012; 2012:512790. [PMID: 23227408 PMCID: PMC3512244 DOI: 10.1155/2012/512790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/29/2012] [Indexed: 11/17/2022] Open
Abstract
A 62-year-old male presented to the outpatient department of chest with history of dry cough since two months and swelling on the anterior aspect of neck of 30-year duration. Physical examination revealed a goitre. However, further imaging studies revealed presence of another associated pathology, a Kommerell's diverticulum in association with a right aortic arch with aberrant left subclavian artery. The enlarged thyroid was not compressing the trachea, and its occurrence in this case could be incidental. The diverticulum was considered as the cause of chronic cough in our case as it was causing tracheal compression, and also there were no other obvious causes which could explain the symptom. Vascular anomalies such as Kommerell's diverticulum, though uncommon, should be considered in the differential diagnosis of chronic cough particularly when other common causes have been ruled out.
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Taha MM, Nakahara I, Higashi T, Iwamuro Y, Watanabe Y, Taki W. Percutaneous angioplasty and stenting of subclavian arteries before surgical coronary revascularization in a patient with an aberrant right subclavian artery. J Neuroradiol 2008; 34:267-71. [PMID: 17640732 DOI: 10.1016/j.neurad.2007.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
An aberrant right subclavian artery occurs in less than 2% of the population. An associated stenosis of the subclavian artery carries a risk of subclavian-coronary steal in patients who undergo coronary revascularization. We report on the case of a 54-year-old man admitted to our hospital for a coronary artery bypass graft (CABG). Angiographic examination revealed bilateral subclavian-artery stenosis with an aberrant right subclavian artery, anomalous origin of the right vertebral artery from the right common carotid artery, and left vertebral-artery occlusion. The patient underwent successful bilateral subclavian angioplasty and stenting.
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Affiliation(s)
- M M Taha
- Department of Neurosurgery, Kokura Memorial Hospital, 1-1Kifunemachi, Kokurakita-ku, 802-8555 Kitakyusyu-shi Fukuoka, Japan, and Department of Neurosurgery, Zagazig University Hospital, Egypt.
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Total arch replacement for a distal arch aneurysm with aberrant right subclavian artery. Gen Thorac Cardiovasc Surg 2008; 56:22-4. [DOI: 10.1007/s11748-007-0181-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 09/07/2007] [Indexed: 10/22/2022]
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Ota T, Okada K, Takanashi S, Yamamoto S, Okita Y. Surgical treatment for Kommerell’s diverticulum. J Thorac Cardiovasc Surg 2006; 131:574-8. [PMID: 16515907 DOI: 10.1016/j.jtcvs.2005.10.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Revised: 09/09/2005] [Accepted: 10/07/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Kommerell's diverticulum, which is a rare condition, is a congenital abnormality of the aortic arch. The strategy of surgical treatment for Kommerell's diverticulum has not been established. METHODS Between 1994 and 2004, 6 patients underwent surgery for Kommerell's diverticulum at our institute. Diagnoses included right aortic arch with aberrant left subclavian artery in 4 patients and left aortic arch with aberrant right subclavian artery in 2 patients. Indications for surgery were dilatation of Kommerell's aneurysm (n = 4) and dysphagia (n = 2). One patient underwent total arch replacement through the median sternotomy plus right thoracotomy. Five patients underwent replacement of the descending aorta and reconstruction in situ (n = 4) or ligation (n = 1) of the stenotic aberrant subclavian artery through the right (n = 3) or left (n = 2) thoracotomy. RESULTS There were no patient deaths or patients who required rehospitalization. Mediastinitis occurred in 1 patient. This patient required mediastinal drainage and an omentopexy. Two patients who had dysphagia became asymptomatic. Postoperative angiographies in all patients were satisfactory. The patient whose aberrant subclavian artery was ligated had no ischemic symptom of the arm. At the midterm outcomes (mean follow-up length was 55.6 +/- 42.2 months, ranging 10-114 months), all patients resumed normal activities without any complications. CONCLUSIONS Kommerell's diverticulum can be repaired safely with graft replacement concomitant with in situ reconstruction of the aberrant subclavian artery through thoracotomy.
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Affiliation(s)
- Takeyoshi Ota
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Chaoui R, Heling KS, Sarioglu N, Schwabe M, Dankof A, Bollmann R. Aberrant right subclavian artery as a new cardiac sign in second- and third-trimester fetuses with Down syndrome. Am J Obstet Gynecol 2005; 192:257-63. [PMID: 15672034 DOI: 10.1016/j.ajog.2004.06.080] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The right subclavian artery arises normally as the first vessel from the brachiocephalic artery of the aortic arch. An aberrant right subclavian artery arises as a separate vessel from the aortic isthmus and crosses to the right, behind the trachea. This variant is present in <1% of the normal population; however, in subjects with Down syndrome, an incidence between 19% and 36% was reported. The purpose of this study was to assess the possibility of the detection of an aberrant right subclavian artery in fetuses with Down syndrome. STUDY DESIGN Fourteen consecutive fetuses with prenatally detected Down syndrome were examined between 18 and 33 weeks of gestation. The presence of an aberrant right subclavian artery was determined by visualization of the transverse 3-vessel trachea view of the upper thorax with color Doppler ultrasonography. RESULTS The right subclavian artery was visualized in 100% of fetuses (14/14) with Down syndrome. An aberrant right subclavian artery was identified in 35.7% of trisomy 21 fetuses (5/14). In 1 fetus, the aberrant right subclavian artery was the only abnormal ultrasound finding. In 3 fetuses, an aberrant right subclavian artery was associated with an intracardiac echogenic focus plus additional extracardiac markers. In the fourth fetus, an aberrant right subclavian artery was associated with an atrioventricular septal defect. All 9 fetuses with Down syndrome with a normal origin of the right subclavian artery had additional cardiac and/or extracardiac abnormalities. In 12 cases, pregnancy was terminated; 2 fetuses were live born. CONCLUSION This preliminary study suggests that the in utero identification of an aberrant right subclavian artery may be a new ultrasound marker to be found in fetuses with Down syndrome. Further studies are required to assess the incidence of aberrant right subclavian artery in normal fetuses.
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Affiliation(s)
- Rabih Chaoui
- Prenatal Diagnosis and Therapy Unit, Charité Medical School, Humboldt University, Berlin, Germany.
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Gravereaux EC, Nguyen LL, Cunningham LD. Congenital vascular anomalies. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2004; 6:129-138. [PMID: 15066242 DOI: 10.1007/s11936-004-0041-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Congenital vascular anomalies are rare. The cardiovascular specialist should nevertheless be aware of the more common types of vascular anomalies and understand the implications for patient treatment and the likelihood of associated morbidity. The presentation of congenital arteriovenous malformations can range from asymptomatic or cosmetic lesions, to those causing ischemia, ulceration, hemorrhage, or high-output congestive heart failure. Treatment of large, symptomatic arteriovenous malformations often requires catheter-directed embolization prior to the attempt at complete surgical excision. Later recurrence, due to collateral recruitment, is frequent. Graded compression stockings and leg elevation are the mainstays of treatment for the predominantly venous congenital vascular anomalies. Most congenital central venous disorders are clinically silent. An exception is the retrocaval ureter. Retroaortic left renal vein, circumaortic venous ring, and absent, left-sided or duplicated inferior vena cava are relevant when aortic or inferior vena cava procedures are planned. The treatment of the venous disorders is directed at prevention or management of symptoms. Persistent sciatic artery, popliteal entrapment syndrome, and aberrant right subclavian artery origin are congenital anomalies that are typically symptomatic at presentation. Because they mimic more common diseases, diagnosis is frequently delayed. Delay can result in significant morbidity for the patient. Failure to make the diagnosis of persistent sciatic artery and popliteal entrapment can result in critical limb ischemia and subsequent amputation. Unrecognized aberrant right subclavian artery origin associated with aneurysmal degeneration can rupture and result in death. The treatment options for large-vessel arterial anomalies are surgical, sometimes in combination with endovascular techniques.
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Affiliation(s)
- Edwin C. Gravereaux
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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