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Bhatia H, Aswal CSS, Sharma A, Singhal M. Bicarotid trunk coexisting with anomalous right vertebral and aberrant right subclavian artery. Pediatr Pulmonol 2024; 59:1476-1478. [PMID: 38358033 DOI: 10.1002/ppul.26894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Harsimran Bhatia
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Arun Sharma
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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2
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Zidere V, Vigneswaran TV. Aberrant right subclavian artery: will it need surgery? Ultrasound Obstet Gynecol 2024; 63:570-571. [PMID: 37842801 DOI: 10.1002/uog.27516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023]
Affiliation(s)
- V Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
- Harris Birthright Centre for Fetal Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - T V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
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3
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Matta R, Shah A, Bandesha H, Thiagarajasubramanian S, Muluk S. Case Report: Successful Treatment of Aberrant Left Subclavian Artery With a Right-Sided Aortic Arch. Vasc Endovascular Surg 2024; 58:392-395. [PMID: 37943979 DOI: 10.1177/15385744231215584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Right sided aortic arches with concomitant aberrant left subclavian arteries are exceedingly rare anatomical variants. We present a case of a 45 year old male that presented with symptoms consistent with dysphagia and known right sided aortic arch with an aberrant left subclavian artery. Though previous reports of repair have indeed been reported, we confirm that a hybrid approach to these anatomic variants remain feasible and with symptom resolution for patients.
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Affiliation(s)
- Rishabh Matta
- Division of Vascular Surgery, Department of Thoracic and Cardiovascular surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Anil Shah
- Division of Vascular Surgery, Department of Thoracic and Cardiovascular surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Harmanpreet Bandesha
- Division of Vascular Surgery, Department of Thoracic and Cardiovascular surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Shruthi Thiagarajasubramanian
- Division of Vascular Surgery, Department of Thoracic and Cardiovascular surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Satish Muluk
- Division of Vascular Surgery, Department of Thoracic and Cardiovascular surgery, Allegheny Health Network, Pittsburgh, PA, USA
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4
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Ishikawa K, Ohtake Y, Fukuda M, Endo H, Nakamura H. Dysplastic aberrant left subclavian artery originating from a thoracic intersegmental artery associated with a right aortic arch. Surg Radiol Anat 2024; 46:519-522. [PMID: 38480591 DOI: 10.1007/s00276-024-03333-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/23/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE A right aortic arch (RAA) is a rare vascular anomaly that often coexists with an aberrant left subclavian artery (ALSA). Due to the rarity of RAA, the development of an ALSA is not well understood. METHOD We describe a case in which a 58-year-old man who was scheduled to undergo posterior decompression and fusion surgery for thoracic ossification of the posterior longitudinal ligament from Th1 to Th3 was found to have a RAA and an ALSA. RESULTS Preoperative computed tomography angiography demonstrated a RAA and an ALSA. The ALSA was extremely tortuous and ran in the paraspinal muscles behind the thoracic laminae, which meant it was in the surgical field. The ALSA arose from the descending aorta and bifurcated into the left segmental arteries of Th1 and Th2, and also bifurcated into the left vertebral artery, which had a normal subsequent course. The dysplastic ALSA was considered to have developed from the thoracic intersegmental artery. Based on preoperative examination findings, we performed spinal surgery without vessel injury. CONCLUSION We report a rare case of a dysplastic ALSA that developed from the thoracic intersegmental artery with a RAA. The knowledge of this anomaly provides safety in spinal surgery of the cervicothoracic junction.
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Affiliation(s)
- Kohei Ishikawa
- Department of Neurosurgery, Nakamura Memorial Hospital, 291, Minami 1-jo Nishi 14-chome, Chuo-ku, Hokkaido, Hokkaido, 060-8570, Japan.
| | - Yasufumi Ohtake
- Department of Neurosurgery, Nakamura Memorial Hospital, 291, Minami 1-jo Nishi 14-chome, Chuo-ku, Hokkaido, Hokkaido, 060-8570, Japan
| | - Mamoru Fukuda
- Department of Neurosurgery, Nakamura Memorial Hospital, 291, Minami 1-jo Nishi 14-chome, Chuo-ku, Hokkaido, Hokkaido, 060-8570, Japan
| | - Hideki Endo
- Department of Neurosurgery, Nakamura Memorial Hospital, 291, Minami 1-jo Nishi 14-chome, Chuo-ku, Hokkaido, Hokkaido, 060-8570, Japan
| | - Hirohiko Nakamura
- Department of Neurosurgery, Nakamura Memorial Hospital, 291, Minami 1-jo Nishi 14-chome, Chuo-ku, Hokkaido, Hokkaido, 060-8570, Japan
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5
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Shehab M, Kosykh S, Wolf A, Haddad M, Fajer S, Hoffman RS, Bachar AR. Aberrant Right Subclavian Artery: Demographics, Morphological Features and Follow up CT Scans Dynamics. Vasc Endovascular Surg 2024; 58:172-177. [PMID: 37766474 DOI: 10.1177/15385744231203754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Introduction: Aberrant right subclavian artery (ARSA) is the most common of the aortic arch anomalies, occurring in .5% to 1% of the population. There is no standardized follow up protocol, especially in the asymptomatic cases. The purpose of the present study was to evaluate the natural history of ARSA and the role of serial CT scans. Methods: This is a single-center retrospective study of patients with ARSA depicted on chest computed tomography (CT) scans between February 2013 and July 2022. Data were collected from their medical records. Measurements of the aorta at different segments including the aortic diameter at the orifice of ARSA, and ARSA at ostium followed by 1 cm intervals were collected, as well as for follow-up CT scans. Results: 65 patients were diagnosed with ARSA, 70.8% of whom were women. The average age for the cohort was 58.569 ± 16.99 years. The median follow up time was 4 years (range 0-10 years), KM estimated survival after ARSA diagnosis at 1 and 5 years as 97% and 93%, respectively. Nineteen patients had a second CT scan and were included in the morphological CT dynamic analysis, on average of 29 ± 27 months apart (range 7-108). The mean ARSA diameter at origin was larger in the second scan 16.91 ± 4.31 mm compared to the initial scan 16.31 ± 4.96 mm, (P = .04).The mean aortic arch diameter in the first and second CT were 28.54 ± 4.24 and 29.64 ± 5.14 (P = .10), respectively. All other measurements did not disclose any significant enlargement over time. Conclusions: Our cohort demonstrate a benign natural history of ARSA with slow growth rates. However, due to our small sample size we can't draw a clinically sound recommendation on the need for imaging follow up, and further larger cohort with longer follow up interval are required.
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Affiliation(s)
- Maysam Shehab
- Vascular Surgery Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Stanislav Kosykh
- Radiology Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Ammie Wolf
- Vascular Surgery Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Menashe Haddad
- Vascular Surgery Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Simone Fajer
- Vascular Surgery Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Roetm Sivan Hoffman
- Radiology Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Adi R Bachar
- Vascular Surgery Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
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6
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Griffeth EM, Stephens EH, Dearani JA, Francois C, Todd A, Miranda WR, Connolly HM, Bonnichsen CR, Pochettino A. Outcomes of Surgical Repair of Aberrant Subclavian Arteries in Adults. Ann Thorac Surg 2024; 117:396-402. [PMID: 37030428 PMCID: PMC10556195 DOI: 10.1016/j.athoracsur.2023.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/24/2023] [Accepted: 03/20/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Symptoms, imaging characteristics, and early and midterm surgical outcomes for aberrant subclavian arteries (ASCA) are not well defined in the adult population. METHODS A single-institution retrospective review was conducted of adults undergoing surgical repair of ASCA and descending aorta origin/Kommerell diverticulum (KD) from January 1, 2002, to December 31, 2021. Symptom improvement and differences in imaging characteristics between anatomic groups and the number of symptoms were assessed. RESULTS Mean age was 46 ± 17 years. There were 23 of 37 left aortic arches with right ASCA (62%) and 14 of 37 right aortic arches with left ASCA (38%). Of these, 31 of 37 (84%) were symptomatic, and 19 of 37 (51%) had KD size/growth meeting criteria for surgical repair. KD aortic origin diameter was larger in more symptomatic patients: 20.60 mm (interquartile range [IQR], 16.42-30.68 mm) in patients with ≥3 symptoms vs 22.05 mm (IQR, 17.52-24.21 mm) for 2 symptoms vs 13.72 mm (IQR, 12.70-15.95 mm) for 1 symptom (P = .018). Aortic replacement was required in 22 of 37 (59%). There were no early deaths. Complications occurred in 11 of 37 (30%): vocal cord dysfunction (4 of 37 [11%]), chylothorax (3 of 37 [8%]), Horner syndrome (2 of 37 [5%]), spinal deficit (2 of 37 [5%]), stroke (1 of 37 [3%]), and temporary dialysis requirement (1 of 37 [3%]). Over a median follow-up of 2.3 years (IQR, 0.8-3.9 years), there was 1 endovascular reintervention and no reoperations. Dysphagia and shortness of breath resolved in 92% and 89%, respectively, whereas gastroesophageal reflux persisted in 47%. CONCLUSIONS The KD aortic origin diameter correlates with the number of symptoms, and surgical repair of ASCA and descending aorta origin/KD effectively relieves symptoms, with low rates of reintervention. Given the operative complexity, surgical repair should be performed in patients meeting size criteria or with significant dysphagia or shortness of breath symptoms.
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Affiliation(s)
- Elaine M Griffeth
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Austin Todd
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - William R Miranda
- Division of Structural Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Heidi M Connolly
- Division of Structural Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Crystal R Bonnichsen
- Division of Structural Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Lei MX, Cao Y, Yuan MQ. Aberrant right subclavian artery associated with common carotid trunk. J Vasc Surg 2024; 79:147. [PMID: 37777946 DOI: 10.1016/j.jvs.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Mei-Xian Lei
- Department of Cardiology, Jiujiang First People's Hospital, Jiujiang, Jiangxi, China
| | - Yuan Cao
- Department of Cardiology, Jiujiang First People's Hospital, Jiujiang, Jiangxi, China
| | - Ming-Qing Yuan
- Department of Cardiology, Jiujiang First People's Hospital, Jiujiang, Jiangxi, China.
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8
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Cheong D, Jhaveri S, Smerling J, Rajagopal H, Misra N, Meyer DB. Association and Repair of Right Aortic Arch With Aberrant Left Subclavian Artery With Subclavian Stenosis. World J Pediatr Congenit Heart Surg 2024; 15:133-136. [PMID: 37728165 DOI: 10.1177/21501351231194256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Surgical repair of right aortic arch and aberrant left subclavian artery has traditionally involved ligamentum division. Such patients can have stenosis at the origin of the aberrant subclavian artery either at the time of presentation or later. The more recently popularized repair involving resection of Kommerell diverticulum with transfer of the subclavian artery to the left carotid artery allows resection of the stenotic segment and serves as an effective treatment for subclavian stenosis as well. We present three cases of early repair of this arch anomaly with associated subclavian stenosis repaired successfully in that manner.
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Affiliation(s)
- Daniel Cheong
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Simone Jhaveri
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Jonathan Smerling
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Hari Rajagopal
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Nilanjana Misra
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - David B Meyer
- Division of Cardiothoracic Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
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Solano A, Pizano A, Azam J, Gonzalez-Guardiola G, Siah M, Chamseddin K, Prakash V, Kirkwood ML, Shih M. Kommerell's Diverticulum in a Right-Sided Aortic Arch With an Aberrant Left Subclavian Artery Hybrid Repair. Vasc Endovascular Surg 2023; 57:954-959. [PMID: 37310394 PMCID: PMC10543133 DOI: 10.1177/15385744231183310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Kommerell's diverticulum (KD) with a right aortic arch (RAA) and aberrant left subclavian artery (aLSCA) is a rare congenital anomaly of the aortic arch. Treatment is not well defined due to its uncommon presentation, with rupture and dissection risk rates of up to 53%. CASE SUMMARY A 54-year-old male with a history of chronic obstructive pulmonary disease (COPD) and hypertension presented with difficulty breathing during exercise without dysphagia. Follow-up computerized tomography angiogram (CTA) revealed the presence of a RAA and aLSCA arising from the descending thoracic aorta with an adjacent 58 × 41-mm KD and tracheal and esophageal displacement. Due to the size of the KD, risk of rupture, unsuitable anatomy for total endovascular aortic repair (EVAR), and high COPD burden, the patient was planned to undergo a hybrid surgical repair. Left common carotid (LCCA) artery to LSCA bypass, full aortic debranching, LSCA embolization and percutaneous thoracic endovascular aortic repair (TEVAR) were performed. Successful device position and exclusion of the diverticulum and aneurysmal aorta were observed after completion thoracic aortogram. 18-month follow-up CTA demonstrated patency of the LSCA to LCCA bypass graft and arch vessel branches, as well as stable exclusion of the KD. Persistence of a type II endoleak originated at the right first posterior intercostal artery has been noted and is being followed conservatively since no sac growth has occurred. CONCLUSION We highlight the presence of a KD with RAA and aberrant subclavian artery, a rare congenital anatomic variation of the aortic arch with complex anatomy. Surgical planning must be individualized according to comorbidities and anatomical variations identified on imaging and 3D reconstructions.
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Affiliation(s)
- Antonio Solano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Alejandro Pizano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Jawaher Azam
- Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA Presented at the poster session of the Critical Issues America Annual Meeting. Miami, FL, February 10-11, 2023
| | - Gerardo Gonzalez-Guardiola
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Michael Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Khalil Chamseddin
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Vivek Prakash
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Melissa L. Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
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Schweighofer N, Dolinšek J, Rupreht M. Arteria Lusoria as a Cause of Dysphagia in an Infant. J Pediatr Health Care 2023; 37:702-705. [PMID: 37516943 DOI: 10.1016/j.pedhc.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/05/2023] [Accepted: 07/11/2023] [Indexed: 07/31/2023]
Abstract
The aberrant right subclavian artery (i.e., arteria lusoria) arising from the left part of the aortic arch is a rare congenital anomaly. In some patients, esophageal compression may cause symptoms of dysphagia, also called dysphagia lusoria. It can cause serious feeding disorders and poor weight gain in young children. We present the case of an early onset of dysphagia lusoria in a 1-month-old girl whose clinical diagnosis was confirmed by esophagography and magnetic resonance imaging. This kind of vascular anomaly can present a diagnostic challenge and should be considered in diagnosing dysphagia in childhood.
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11
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Bram R, Atwal G. Transradial flow diversion with an aberrant right subclavian artery. J Neurointerv Surg 2023; 15:1164. [PMID: 36958827 DOI: 10.1136/jnis-2023-020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
Transradial access for diagnostic and therapeutic neurointerventional procedures has gained popularity due to a decreased incidence of access site complications and improved patient comfort compared with transfemoral access.1-4 An aberrant right subclavian artery is an aortic arch variant characterized by a right subclavian artery that arises directly from the arch as the most distal great vessel. Transradial access with an aberrant right subclavian artery is anatomically challenging due to the predilection of the catheter system to collapse into the descending aorta. In this (video 1), we describe a step-by-step technique for transradial access in a patient with an aberrant right subclavian artery undergoing endovascular flow diversion for a left superior hypophyseal artery aneurysm. Particular emphasis is placed on the technique for accessing the proximal arch and aortic valve as well as distal catheter navigation while avoiding prolapse into the descending aorta. neurintsurg;15/11/1164/V1F1V1Video 1 .
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Affiliation(s)
- Richard Bram
- Neurosurgery, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Gursant Atwal
- Neurosurgery, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
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12
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Inomata Y, Hanaoka Y, Koyama JI, Yamazaki D, Kitamura S, Nakamura T, Horiuchi T. Left Transradial Access Using a Radial-Specific Neurointerventional Guiding Sheath for Coil Embolization of Anterior Circulation Aneurysm Associated With the Aberrant Right Subclavian Artery: Technical Note and Literature Review. World Neurosurg 2023; 178:126-131. [PMID: 37506842 DOI: 10.1016/j.wneu.2023.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Aberrant right subclavian artery (ARSA) is a rare condition, but the most common anomaly of the aortic arch. Although neurointerventions via transradial access (TRA) are becoming increasingly popular worldwide, transradial carotid cannulation has been extremely challenging in patients with an ARSA. Herein, we present a case of ARSA-associated anterior communicating artery (ACoA) aneurysm that was successfully treated with a radial-specific 6F Simmons guiding sheath via left TRA. We also review the relevant literature. METHODS A 68-year-old-woman who was diagnosed as having an ARSA-associated ACoA aneurysm underwent simple coiling via left TRA. After the 6F Simmons guiding sheath was engaged into the right common carotid artery using the pull-back-technique, transradial quadraxial system (6F Simmons guiding sheath/6F intermediate catheter/3.2F intermediate catheter/coil-delivery microcatheter) was implemented. RESULTS Simple coiling of the aneurysm was successfully achieved without catheter kinking or system instability. The postprocedural course was uneventful. A follow-up magnetic resonance angiography showed no evidence of recanalization 1 years 9 months after the procedure. CONCLUSIONS Transradial anterior circulation intervention has been rarely used for patients with an ARSA due to unfavorable catheter trajectory. Left TRA using the 6F Simmons guiding sheath is a useful treatment option to address anterior circulation interventions for patients with an ARSA. Preoperative diagnosis of ARSA is necessary for the application of our method.
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Affiliation(s)
- Yuki Inomata
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan.
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Daisuke Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Kitamura
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Takuya Nakamura
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
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13
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Jones EL, Riangwiwat T, Blankenship JC. A Simple Method to Diagnose Arteria Lusoria During Right Radial Access Coronary Intervention. Cardiovasc Revasc Med 2023; 53S:S227-S229. [PMID: 35868996 DOI: 10.1016/j.carrev.2022.06.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/06/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022]
Abstract
Arteria lusoria (aberrant right subclavian artery) occurs in approximately 0.1-2.4 % of all individuals. The resulting tortuosity can pose a challenge for coronary angiography using radial artery access, but also can aid in the diagnosis if not already established. This case series reports three patients diagnosed with arteria lusoria by a single low-volume catheterization operator over a 6-month period, noting that its prevalence may be higher than usually reported, can be suspected when a catheter from the right radial artery crosses the midline and forms a loop as it traverses to the ascending aorta, and that it does not preclude successful catheterization and coronary intervention.
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Affiliation(s)
- Erika L Jones
- Division of Cardiology, University of New Mexico, Albuquerque, NM, United States of America
| | - Tanawan Riangwiwat
- Department of Cardiology, Geisinger Medical Center, Danville, PA, United States of America
| | - James C Blankenship
- Division of Cardiology, University of New Mexico, Albuquerque, NM, United States of America.
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14
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Shi B, Han Z, Zhang W, Li W. The clinical value of color ultrasound screening for fetal cardiovascular abnormalities during the second trimester: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e34211. [PMID: 37443473 PMCID: PMC10344501 DOI: 10.1097/md.0000000000034211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND This meta-analysis aimed to investigate the diagnostic value of color ultrasound screening for fetal cardiovascular abnormalities during the second trimester in China. METHODS A literature search was conducted to evaluate the clinical value of color ultrasound screening for fetal cardiovascular abnormalities during the second trimester using English and Chinese databases. Numerical values for sensitivity and specificity were obtained from false-negative, false-positive, true-negative, and true-positive rates, presented alongside graphical representations with boxes marking the values and horizontal lines showing the confidence intervals. Summary receiver operating characteristic (SROC) curves were applied to assess the performance of the diagnostic tests. Data were processed using Review Manager 5.3. RESULTS Four studies (151 patients with fetal cardiovascular abnormalities and 3397 undiagnosed controls) met our evaluation criteria. The sensitivity was 0.91 and 0.96, respectively, and the specificity was 1.00. The Area Under the Curve (AUC) from the SROC curves was >90%; therefore, it was classified as excellent. Furthermore, there were 6 types of fetal cardiovascular abnormalities, and the pooled screening rate of atrioventricular septal defects was the highest. CONCLUSION Our meta-analysis showed that the use of color ultrasound during the second trimester can be an excellent diagnostic tool for fetal cardiovascular abnormalities.
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Affiliation(s)
- Bingye Shi
- Color Ultrasound Room, Affiliated Hospital of Hebei University, Baoding, China
| | - Zhe Han
- Department of Cardiac Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Wei Zhang
- Medical Engineering Center, Affiliated Hospital of Hebei University, Baoding, China
| | - Wenxiu Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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15
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Mawait N, Kerzmann A, Desiron Q, Henroteaux D, Stiennon L, Defraigne JO. [Dysphagia lusoria treated by surgery]. Rev Med Liege 2023; 78:411-414. [PMID: 37560951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Aberrant right subclavian artery, also called arteria lusoria, is the most common congenital anomaly of the aortic arch (prevalence 0,5-1.8 %). Patients with trisomy 21 have a higher prevalence (35 %). It takes its origin from the aortic arch after the three others supra-aortic trunks. It may be associated with other cardiovascular anomalies. In more than 80 % of cases, the aberrant artery is positioned behind the oesophagus. It is often asymptomatic. Sometimes it is associated with symptoms after the age of 40 years old, more often among women: dysphagia (dysphagia lusoria), dyspnoea or cough. Diagnosis is made by computed tomography or magnetic resonance imaging. When it is symptomatic, a barium contrast radiography of the oesophagus is indicated. Surgical treatment by transposition of the aberrant vessel is performed only for symptomatic patients. We report the case of a 50-year-old woman with dysphagia lusoria treated by transposition of the aberrant right subclavian artery into the right common carotid through a cervical approach.
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Affiliation(s)
- Natacha Mawait
- Service de Chirurgie cardiovasculaire et thoracique, CHU Liège, Belgique
| | - Arnaud Kerzmann
- Service de Chirurgie cardiovasculaire et thoracique, CHU Liège, Belgique
| | - Quentin Desiron
- Service de Chirurgie cardiovasculaire et thoracique, CHU Liège, Belgique
| | | | - Laurie Stiennon
- Service de Chirurgie cardiovasculaire et thoracique, CHU Liège, Belgique
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16
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Olson CG, Cortés P, Stancampiano FF, Valery JR, Bi Y, Pocchetino A, Harris DM. Diagnosis, symptoms, and treatment knowledge of aberrant right subclavian artery in followers of a social media group. Rom J Intern Med 2023; 61:3-5. [PMID: 36278963 DOI: 10.2478/rjim-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Caroline G Olson
- Division of Internal Medicine, Mayo Clinic Jacksonville, FL 32224
| | - Pedro Cortés
- Division of Internal Medicine, Mayo Clinic Jacksonville, FL 32224
| | | | - Jose R Valery
- Division of Internal Medicine, Mayo Clinic Jacksonville, FL 32224
| | - Yan Bi
- Division of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL 32224
| | | | - Dana M Harris
- Division of Internal Medicine, Mayo Clinic Jacksonville, FL 32224
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17
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Cho JS. Unraveling the enigma of an aberrant subclavian artery (arteria lusoria). J Vasc Surg 2022; 75:1349-1350. [PMID: 35314040 DOI: 10.1016/j.jvs.2021.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/28/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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18
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Shimabukuro K, Sakai O, Fujii R, Ogura H, Umeda E, Kato T, Doi K. Simplified Endovascular Treatment of Aberrant Right Subclavian Artery with Kommerell's Diverticulum. Ann Thorac Surg 2022; 113:e401. [PMID: 35031291 DOI: 10.1016/j.athoracsur.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/25/2021] [Accepted: 12/05/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Katsuya Shimabukuro
- Department of Cardiovascular Surgery, Division of Surgery, Gifu University Hospital, Gifu, Japan.
| | - Osamu Sakai
- Department of Cardiovascular Surgery, Division of Surgery, Gifu University Hospital, Gifu, Japan
| | - Ryo Fujii
- Department of Cardiovascular Surgery, Division of Surgery, Gifu University Hospital, Gifu, Japan
| | - Hiroki Ogura
- Department of Cardiovascular Surgery, Division of Surgery, Gifu University Hospital, Gifu, Japan
| | - Etsuji Umeda
- Department of Cardiovascular Surgery, Division of Surgery, Gifu University Hospital, Gifu, Japan
| | - Takayoshi Kato
- Department of Cardiovascular Surgery, Division of Surgery, Gifu University Hospital, Gifu, Japan
| | - Kiyoshi Doi
- Department of Cardiovascular Surgery, Division of Surgery, Gifu University Hospital, Gifu, Japan
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19
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Nagata T, Iwakoshi S, Yamada T, Johno H. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6554031. [PMID: 35333342 PMCID: PMC9297499 DOI: 10.1093/icvts/ivac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/28/2022] [Accepted: 03/11/2022] [Indexed: 11/14/2022] Open
Abstract
The best treatment for a right-sided aortic arch (RAA) and Kommerell diverticulum (KD) has not been determined due to the rarity of these conditions. The current trend in the treatment of this disease is to increase the endovascular approach without a sternotomy. We describe a rare condition with an association of an RAA with a KD of an aberrant left subclavian artery and an anomalous right vertebral artery originating from the aortic arch (AVA). The left vertebral artery was missing. Also, there was an incomplete circle of Willis due to the absence of the left and right posterior communication arteries. Therefore, the AVA was the only artery to supply the vertebral-basilar system. In our case, a simple thoracic endovascular aortic repair was not suitable because of the sharply curved arch and short landing zone. Also, a debranching thoracic endovascular aortic repair was not appropriate because that approach would not permit reconstruction of the AVA. The patient successfully underwent a total arch replacement with the frozen elephant trunk technique. This procedure could be an effective option for patients with RAAs with KDs associated with another arch vessel anomaly.
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Affiliation(s)
- Tomoki Nagata
- Department of Cardiovascular Surgery, Takaishi Fujii Cardiovascular Hospital, 2-15-18 Ayazono, Takaishi-shi, Osaka, 592-0014, Japan
- Address for correspondence. Department of Cardiovascular Surgery, Takaishi Fujii Cardiovascular Hospital, 2-15-18 Ayazono, Takaishi-shi, Osaka, 592-0014, Japan. Tel: (+81) 72-263-5050; fax: (+81) 72-263-5051; e-mail: (T. Nagata)
| | - Shinichi Iwakoshi
- Department of Radiology, Nara Medical University, 840 Shijo, Kashihara-shi, Nara, 634-8521, Japan
| | - Takashi Yamada
- Department of Cardiology, Takaishi Fujii Cardiovascular Hospital, 2-15-18 Ayazono, Takaishi-shi, Osaka, 592-0014, Japan
| | - Hiroyuki Johno
- Department of Cardiovascular Surgery, Takaishi Fujii Cardiovascular Hospital, 2-15-18 Ayazono, Takaishi-shi, Osaka, 592-0014, Japan
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20
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Nakamura Y, Tsuruta K, Shindo Y, Arai W, Maki R, Miyajima M, Watanabe A. [Congenital Pericardial Defect Incidentally Found at Thoracoscopic Left Upper Lobe Resection:Report of a Case]. Kyobu Geka 2021; 74:1051-1054. [PMID: 34795153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We report a rare case of a congenital pericardial defect that was incidentally found at thoracoscopic left upper lobe resection in a patient with lung cancer. A 75-year-old man with a left upper lobe lung cancer was referred to our hospital. We performed thoracoscopic left upper lobectomy and incidentally found a pericardial defect intraoperatively. Careful lymph node dissection was necessary to avoid injury of phrenic nerve and pulmonary artery. Surgery for lung cancer was completed without pericardial repair. After surgery, no complications associated with the pericardial defect has not been encountered.
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Affiliation(s)
- Yasuyuki Nakamura
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, Sapporo, Japan
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21
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Kumar S, Mishra M. Triple thoracic anomalies: right-sided aortic arch, aberrant left subclavian artery and Kommerell's diverticulum. BMJ Case Rep 2021; 14:e245539. [PMID: 34389603 PMCID: PMC8365793 DOI: 10.1136/bcr-2021-245539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Subodh Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, India
| | - Mayank Mishra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, India
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22
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Hale BW, Lu JC, Romano JC, Lowery R, Yu S, Norris MD. Kommerell diverticulum: distinctions between arch side, and evaluation of morphology, size, and risk. Ann Thorac Surg 2021; 114:848-856. [PMID: 34283954 DOI: 10.1016/j.athoracsur.2021.06.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/05/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Kommerell diverticulum (KD) is a dilated proximal aberrant subclavian artery associated with either right or left aortic arches (RAA-ARSA or LAA-ALSA). Although case series suggest KD may be a liability for vascular complications, the risk, pattern of dilation throughout the lifespan, and differences between arch sides, are not known. METHODS A single-center retrospective review of patients of all ages with KD on cross-sectional imaging. Maximal short axis diameter of KD (KDmax), absolute and indexed to descending aortic (DAo) diameter, was correlated with age. Comparisons were made between arch sides. Patients with vascular complications are described. RESULTS One hundred and four patients with KD were included [68 (65%) RAA-ALSA, 36 (35%) LAA-ARSA; 43 (41%) asymptomatic]. Although KDmax was correlated with age (RAA-ALSA r=0.84 [p<.0001]; LAA-ARSA r=0.51 [p=0.001]), KDmax/DAo was not (RAA-ALSA r=0.14 [p=0.27]; LAA-ARSA r=-0.22 [p=0.21]). RAA-ALSA had larger KDmax/DAo (1.02±0.20 vs 0.89±0.18 mm/mm, p=0.002), more symptoms (75% vs 28%, p <.0001), and younger age (median 9.5 vs 61.7 years, p<.0001). Six patients had vascular complications, age 58-80 years, all with LAA-ARSA and risk factors for acquired aneurysms. CONCLUSIONS In older patients, KDmax/DAo was not larger, arguing against isolated KD dilation with age. Diverticula from RAA-ALSA and LAA-ARSA demonstrate different phenotypes, suggesting different disease processes and likely different risk. The incidence of vascular complication was lower than previous reports, and occurred exclusively in patients with LAA-ARSA and aneurysm risk factors. This suggests conservative management of asymptomatic KD is often reasonable, especially with RAA-ALSA.
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Affiliation(s)
- Benjamin W Hale
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan; University of Michigan Adult Congenital Heart Disease Program, Ann Arbor, Michigan.
| | - Jimmy C Lu
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Jennifer C Romano
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Ray Lowery
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Sunkyung Yu
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Mark D Norris
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan; University of Michigan Adult Congenital Heart Disease Program, Ann Arbor, Michigan
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23
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An K, Li S, Yan J, Wang X, Hua Z. Translocation of aberrant left subclavian artery and resection of Kommerell diverticulum during the concomitant repair of intracardiac anomalies. Interact Cardiovasc Thorac Surg 2021; 32:118-121. [PMID: 33221838 DOI: 10.1093/icvts/ivaa226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/16/2020] [Accepted: 09/03/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To assess the safety and efficacy of the translocation of the aberrant left subclavian artery (LSCA) and resection of the Kommerell diverticulum during the concomitant repair of intracardiac anomalies for paediatric patients who had a right-sided aortic arch. METHODS A retrospective review of paediatric patients who were diagnosed right-sided aortic arch, aberrant LSCA, Kommerell diverticulum and intracardiac anomalies between 2015 and 2019 was conducted. Patients who underwent translocation of the aberrant LSCA, diverticulum resection and concomitant intracardiac repair were included. RESULTS Eight patients underwent translocation of aberrant LSCA, diverticulum resection, ligamentum division and concomitant repair of the associated intracardiac anomalies. All patients were male. The median age was 1.3 years (range 0.4-5.5 years) and the median weight was 10.0 kg (range 6.1-21.0 kg). The most commonly combined intracardiac anomaly was a ventricular septal defect. Seven patients (87.5%) had preoperative respiratory or gastrointestinal symptoms. There was no early mortality and no postoperative complications. During the median follow-up of 23 months (range 4-43 months), no patient had residual respiratory or gastrointestinal symptoms. A postoperative computed tomography scan was performed in 3 patients, all of which showed patent LSCA-left carotid artery anastomosis. CONCLUSIONS Translocation of the aberrant LSCA and resection of the Kommerell diverticulum can be safely performed during the concomitant repair of intracardiac anomalies for paediatric patients. This approach could eliminate residual respiratory and gastrointestinal symptoms, and prevent reintervention in the future.
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Affiliation(s)
- Kang An
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Jun Yan
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Xu Wang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Zhongdong Hua
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
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24
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Grasso EC, Romagnoni C, Cottini M, Gelpi G. Hybrid endovascular/surgical Kommerrell's diverticulum treatment. Ann Vasc Surg 2021; 76:600.e15-600.e17. [PMID: 34182118 DOI: 10.1016/j.avsg.2021.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/04/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022]
Abstract
Kommerrell's diverticulum of the right aberrant subclavian artery is a rare disease, its treatment is still controversial. We report the case of a patient with a six cm aneurysmal dilation successfully treated in a hybrid surgical/endovascular way.
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Affiliation(s)
- Emanuele Carmelo Grasso
- Department of Cardiovascular Surgery, ASST Fatebenefratelli Sacco, Milano, Italy Milano, Italy.
| | - Claudia Romagnoni
- Department of Cardiovascular Surgery, ASST Fatebenefratelli Sacco, Milano, Italy Milano, Italy
| | - Marzia Cottini
- Department of Cardiovascular Surgery, ASST Fatebenefratelli Sacco, Milano, Italy Milano, Italy
| | - Guido Gelpi
- Department of Cardiovascular Surgery, ASST Fatebenefratelli Sacco, Milano, Italy
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25
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Lourenço CSFP, Carriço AL, Valente FMDS. Prenatal Diagnosis of Aberrant Right Subclavian Artery: Association with Genetic Abnormalities. Rev Bras Ginecol Obstet 2021; 43:452-456. [PMID: 34318470 PMCID: PMC10411214 DOI: 10.1055/s-0041-1732461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/05/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The objective of the present study was to determine the frequency of malformations and chromosomal abnormalities in a population of fetuses with an aberrant right subclavian artery (ARSA). METHODS This is a 6-year retrospective study of fetuses with a prenatal diagnosis of ARSA conducted during the period between September 2013 and June 2019 at a fetal medicine unit. Data were collected from ultrasound, fetal echocardiograms, genetic studies, and neonatal records. RESULTS An ARSA was diagnosed in 22 fetuses. An ARSA was an isolated finding in 18 out of 22 cases (82%). Associated abnormal sonographic findings were found in 4 cases. All cases underwent invasive testing. In 1 of the cases, a chromosomal abnormality was detected (mos 45,X [13]/46,X,e(X) (p22.1q22.1)). No cases of congenital heart disease were found in any of these fetuses. There were two cases in which the postnatal evaluation revealed a malformation: one case of hypospadias and 1 case of cleft palate. CONCLUSION The presence of an isolated ARSA is benign and is not associated with chromosomal abnormalities. The finding of ARSA, however, warrants a detailed fetal ultrasound in order to exclude major fetal abnormalities and other soft markers.
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Affiliation(s)
| | - Ana Luísa Carriço
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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26
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Leyssens L, Pestiaux C, Kerckhofs G. A Review of Ex Vivo X-ray Microfocus Computed Tomography-Based Characterization of the Cardiovascular System. Int J Mol Sci 2021; 22:3263. [PMID: 33806852 PMCID: PMC8004599 DOI: 10.3390/ijms22063263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/27/2022] Open
Abstract
Cardiovascular malformations and diseases are common but complex and often not yet fully understood. To better understand the effects of structural and microstructural changes of the heart and the vasculature on their proper functioning, a detailed characterization of the microstructure is crucial. In vivo imaging approaches are noninvasive and allow visualizing the heart and the vasculature in 3D. However, their spatial image resolution is often too limited for microstructural analyses, and hence, ex vivo imaging is preferred for this purpose. Ex vivo X-ray microfocus computed tomography (microCT) is a rapidly emerging high-resolution 3D structural imaging technique often used for the assessment of calcified tissues. Contrast-enhanced microCT (CE-CT) or phase-contrast microCT (PC-CT) improve this technique by additionally allowing the distinction of different low X-ray-absorbing soft tissues. In this review, we present the strengths of ex vivo microCT, CE-CT and PC-CT for quantitative 3D imaging of the structure and/or microstructure of the heart, the vasculature and their substructures in healthy and diseased state. We also discuss their current limitations, mainly with regard to the contrasting methods and the tissue preparation.
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Affiliation(s)
- Lisa Leyssens
- Institute of Mechanics, Materials, and Civil Engineering, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium; (L.L.); (C.P.)
- Institute of Experimental and Clinical Research, Université Catholique de Louvain, 1200 Woluwe-Saint-Lambert, Belgium
| | - Camille Pestiaux
- Institute of Mechanics, Materials, and Civil Engineering, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium; (L.L.); (C.P.)
- Institute of Experimental and Clinical Research, Université Catholique de Louvain, 1200 Woluwe-Saint-Lambert, Belgium
| | - Greet Kerckhofs
- Institute of Mechanics, Materials, and Civil Engineering, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium; (L.L.); (C.P.)
- Institute of Experimental and Clinical Research, Université Catholique de Louvain, 1200 Woluwe-Saint-Lambert, Belgium
- Department of Materials Engineering, Katholieke Universiteit Leuven, 3001 Leuven, Belgium
- Prometheus, Division of Skeletal Tissue Engineering, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
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27
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Roozen GVT, Meel R, Peper J, Venter WDF, Barth RE, Grobbee DE, Klipstein-Grobusch K, Vos AG. Electrocardiographic and echocardiographic abnormalities in urban African people living with HIV in South Africa. PLoS One 2021; 16:e0244742. [PMID: 33529208 PMCID: PMC7853516 DOI: 10.1371/journal.pone.0244742] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/15/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Studies from high income countries report that HIV-positive people have an impaired systolic and diastolic cardiac function compared to HIV-negative people. It is unclear if results can be translated directly to the Sub-Saharan Africa context. This study assesses electro- and echocardiographic characteristics in an urban African population, comparing HIV-positive people (treated and not yet treated) with HIV-negative controls. METHODS We conducted a cross-sectional study in Johannesburg, South Africa. We enrolled HIV-positive participants from three randomized controlled trials that had recruited participants from routine HIV testing programs. HIV-negative controls were recruited from the community. Data were collected on demographics, cardiovascular risk factors, medical history and electrocardiographic and echocardiographic characteristics. RESULTS In total, 394 HIV-positive participants and 153 controls were enrolled. The mean age of HIV-positive participants was 40±9 years (controls: 35±10 years), and 34% were male (controls: 50%). Of HIV-positive participants 36% were overweight or obese (controls: 44%), 23% had hypertension (controls: 28%) and 12% were current smoker (controls: 37%). Median time since HIV diagnosis was 6.0 years (IQR 2.3-10.0) and median treatment duration was 4.0 years (IQR 0.0-8.0), 50% had undetectable viral load. The frequency of anatomical cardiac abnormalities was low and did not differ between people with and without HIV. We observed no relation between HIV or anti-retroviral therapy (ART) and systolic or diastolic heart function. There was an association between ART use and corrected QT interval: +11.8 ms compared to HIV-negative controls (p<0.01) and +18.9 ms compared to ART-naïve participants (p = 0.01). We also observed a higher left ventricular mass index in participants on ART (+7.8 g/m2, p<0.01), but this association disappeared after adjusting for CD4 cell count, viral load and HIV-duration. CONCLUSION The low number of major cardiac abnormalities in this relatively young, well managed urban African HIV-positive population is reassuring. The increase in corrected QT interval and left ventricular mass may contribute to higher cardiac mortality and morbidity in people living with HIV in the long term.
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Affiliation(s)
- Geert V. T. Roozen
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ruchika Meel
- Division of Cardiology, Department of Internal Medicine, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Joyce Peper
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - William D. F. Venter
- Ezintsha, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Roos E. Barth
- Department of Infectious Disease, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alinda G. Vos
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Ezintsha, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- * E-mail:
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Fernández Álvarez P, Valladolid León JM, Caunedo Álvarez Á. Esophageal compression by a mediastinal vascular structure as a result of a dysphagia lusoria. Rev Esp Enferm Dig 2020; 112:505. [PMID: 32379480 DOI: 10.17235/reed.2020.6592/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dysphagia lusoria is an uncommon cause of mechanical dysphagia due to extrinsic compression. It is a congenital aortic root abnormality that occurs as a consequence of an aberrant right subclavian artery, in most cases. We report an illustrative case of dysphagia lusoria in a young female, secondary to the presence of the abnormal mediastinal vessel.
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29
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Ma B, Wu L, Zhang W. Rare vascular ring of right aortic arch and aberrant left subclavian artery in association with bilateral ductus arteriosus. Ultrasound Obstet Gynecol 2020; 55:135-137. [PMID: 31162848 DOI: 10.1002/uog.20365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/17/2019] [Accepted: 05/24/2019] [Indexed: 06/09/2023]
Affiliation(s)
- B Ma
- Department of Ultrasound, Gansu Provincial Maternity and Child-care Hospital, Gansu Province, China
| | - L Wu
- Department of Cardiology, Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - W Zhang
- Department of Pediatric Cardiology, Gansu Provincial Maternity and Child-care Hospital, Gansu Province, China
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Zhao C, Sun Y, Wang Y, Li G, Meng P, Liu S, Yang J, Ma C. Bicuspid aortic valve with right-sided aortic arch aneurysm and Kommerell's diverticulum. J Clin Ultrasound 2019; 47:558-560. [PMID: 31099027 DOI: 10.1002/jcu.22733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 03/13/2019] [Accepted: 05/02/2019] [Indexed: 06/09/2023]
Abstract
Bicuspid aortic valve (BAV) is a common congenital cardiac malformation, frequently combined with ascending aorta dilation. However, isolated abnormalities of the aortic arch are less frequent in BAV patients. Here, we present a rare case of BAV combined with right-sided aortic arch aneurysm, aberrant left subclavian artery, and Kommerell's diverticulum, diagnosed by echocardiography and computed tomography angiography. The patient was followed-up regularly because of the life-threatening risks of aortic arch aneurysms.
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Affiliation(s)
- Cuiting Zhao
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yang Sun
- Radiology Department, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yonghuai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Guangyuan Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Pingping Meng
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Shuang Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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Affiliation(s)
- Moon Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Correspondence to Gwang Ha Kim, M.D. Tel: +82-51-240-7869 Fax: +82-51-244-8180 E-mail:
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Straub L, Huybrechts KF, Bateman BT, Mogun H, Gray KJ, Holmes LB, Hernandez-Diaz S. The Impact of Technology on the Diagnosis of Congenital Malformations. Am J Epidemiol 2019; 188:1892-1901. [PMID: 31241162 PMCID: PMC6825822 DOI: 10.1093/aje/kwz153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/29/2019] [Accepted: 06/04/2019] [Indexed: 12/21/2022] Open
Abstract
As technology improves and becomes more widely accessible, more subclinical congenital malformations are being detected. Using a cohort of 1,780,156 pregnant women and their offspring nested in the 2000-2013 US Medicaid Analytic eXtract, we contrasted time trends in malformations which do not necessarily present with overt clinical symptoms early in life and are more likely to be diagnosed via imaging (secundum atrial septal defect, patent ductus arteriosus, ventricular septal defect, pulmonary artery anomalies, pulmonary valve stenosis, hydrocephalus) with trends in malformations that are unlikely to escape clinical diagnosis (tetralogy of Fallot, coarctation of the aorta, transposition of the great vessels, hypoplastic left heart syndrome, oral cleft, abdominal wall defect). Logistic regression was used to account for trends in risk factors while assessing the impact of increased screening intensity. Prevalence of the diagnosis of secundum atrial septal defect rose from 2.3‰ in 2000-2001 to 7.5‰ in 2012-2013, of patent ductus arteriosus from 1.9‰ to 4.1‰, and of ventricular septal defect from 3.6‰ to 4.5‰. Trends were not explained by changes in the prevalence of risk factors but were attenuated when accounting for screening tests. The other malformations showed no temporal trends. Findings suggest that increased screening partially explains the observed increase in diagnosis of milder cases of select common malformations.
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Affiliation(s)
- Loreen Straub
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kathryn J Gray
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lewis B Holmes
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Medical Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Trahanas JM, Kwolek CJ, Tolis G. Open Tacking of a Migrated Thoracic Endovascular Aortic Graft. Ann Vasc Surg 2019; 63:461.e7-461.e9. [PMID: 31629854 DOI: 10.1016/j.avsg.2019.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/01/2019] [Accepted: 09/13/2019] [Indexed: 11/18/2022]
Abstract
Complications of thoracic endovascular aortic repair (TEVAR) are beginning to emerge as novel vascular issues. While endovascular solutions exist for most, some graft complications require a more traditional open solution. These operations are most commonly performed for endoleak or disease progression. Much less frequently observed is the migration of the endograft requiring open reintervention. Herein we present a case of a proximally migrated TEVAR graft, which required open fixation under deep hypothermic circulatory arrest (DHCA).
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Affiliation(s)
- John M Trahanas
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA.
| | - Christopher J Kwolek
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - George Tolis
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA
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Jhaveri S, Komarlu R. Prenatal diagnosis of right-sided cervical aortic arch with aberrant left subclavian artery and absent ductus arteriosus in tetralogy of Fallot. Ultrasound Obstet Gynecol 2019; 54:414-416. [PMID: 30338597 DOI: 10.1002/uog.20151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Affiliation(s)
- S Jhaveri
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - R Komarlu
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, USA
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Peng A, Ye Y, Feng W, Zhang J, Wang Y, Yin J. Left atrial isomerism with complex cardiovascular malformation on prenatal ultrasound and vascular casting. Ultrasound Obstet Gynecol 2019; 54:285-287. [PMID: 30584674 DOI: 10.1002/uog.20206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Affiliation(s)
- A Peng
- Department of Ultrasound, Xiangyang No. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Hubei, China
| | - Y Ye
- Department of Ultrasound, Xiangyang No. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Hubei, China
| | - W Feng
- Department of Ultrasound, Xiangyang No. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Hubei, China
| | - J Zhang
- Department of Ultrasound, Xiangyang No. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Hubei, China
| | - Y Wang
- Department of Ultrasound, Xiangyang No. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Hubei, China
| | - J Yin
- Department of Ultrasound, Xiangyang No. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Hubei, China
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Tawfik AM, Sobh DM, Ashamallah GA, Batouty NM. Prevalence and Types of Aortic Arch Variants and Anomalies in Congenital Heart Diseases. Acad Radiol 2019; 26:930-936. [PMID: 30266547 DOI: 10.1016/j.acra.2018.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/06/2018] [Accepted: 08/12/2018] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES Aortic arch (AA) variants and anomalies are important to recognize in patients with congenital heart disease (CHD) before surgery or intervention. The aim was to study the prevalence of AA anomalies and variants in patients with CHD compared to a control group. The secondary outcome was to report the associations between common variations of AA and specific types of CHD. MATERIALS AND METHODS After institutional review board approval, computed tomography studies of 352 CHD patients and control group of 400 consecutive computed tomography scans of the thorax were evaluated. The AA was assigned to one of seven common types, and their distribution was compared between CHD and control. The distribution of the AA anomalies and variants was evaluated as regard specific types of CHD and the visceroatrial situs. RESULTS Normal three-vessel branching pattern was the commonest in both groups, but was present in only 50.5% in the CHD compared to 68.5% in the control group, p < 0.00001. Right AA and aberrant right subclavian artery were significantly more common in CHD than control group (18.1% versus 0.25%, p < 0.00001) and (4.5% versus 0.25%, p = 0.0001), respectively. Direct aortic origin of left vertebral artery was insignificantly more common in CHD group (4.2% versus 2.7%, p = 0.258). Brachiobicephalic trunk was significantly more common in control than CHD group (27.7% versus 19.3%, p = 0.007). CONCLUSION Normal three-vessel AA was significantly less common in CHD. AA anomalies (right arch and aberrant right subclavian) were more common in CHD than control, while AA variants (brachiobicephalic trunk and direct aortic origin of left vertebral artery) were not.
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Affiliation(s)
- Ahmed M Tawfik
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
| | - Donia M Sobh
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
| | - Germeen A Ashamallah
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
| | - Nihal M Batouty
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
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Campanale CM, Pasquini L, Santangelo TP, Iorio FS, Bagolan P, Sanders SP, Toscano A. Prenatal echocardiographic assessment of right aortic arch. Ultrasound Obstet Gynecol 2019; 54:96-102. [PMID: 30125417 DOI: 10.1002/uog.20098] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To report our experience with fetal diagnosis of right aortic arch (RAA) variants based on the ductus arteriosus (DA) anatomy and brachiocephalic vessel branching pattern in relation to the trachea, and to establish whether the echocardiographic 'V-shaped' or 'U-shaped' appearance of the junction between the DA and aortic arch (AA) in the fetal upper mediastinal view is sufficiently accurate for assessment of fetal AA anatomy. METHODS This was a retrospective study of pregnancies with a prenatal diagnosis of fetal RAA that had postnatal confirmation of AA anatomy, referred to our tertiary center during 2011-2017. Prenatal and postnatal medical records, including echocardiographic and computed tomography (CT)/magnetic resonance imaging (MRI) scan reports, were reviewed, and cardiac and extracardiac abnormalities and the results of genetic testing were recorded. RESULTS Of 55 consecutive pregnancies with a prenatal diagnosis of fetal RAA, six were lost to follow-up, one was terminated and three were excluded due to lack of postnatal confirmation of AA anatomy. Of the remaining 45 pregnancies, AA anatomy was assessed postnatally by CT in 39, by MRI in one and by direct examination at cardiac surgery in five. A U-shaped appearance was found in 37/45 (82.2%) patients, all of which had a complete vascular ring (CVR). Of these 37 patients, on postnatal confirmation, 21 (56.8%) had RAA with Kommerell's diverticulum, left posterior ductus arteriosus (LPDA) and aberrant left subclavian artery (ALSA) (RAA/LPDA/ALSA), 11 (29.7%) had a double AA (DAA), four (10.8%) had RAA with Kommerell's diverticulum, LPDA and mirror-image (MI) branching (RAA/LPDA/MI), and one (2.7%) had RAA with Kommerell's diverticulum, LPDA and aberrant left innominate artery (ALIA) (RAA/LPDA/ALIA). A V-shaped appearance was found in 3/45 (6.7%) patients, all of which had RAA with right DA not forming a CVR and MI branching. In the 5/45 (11.1%) fetuses with neither U- nor V-shaped appearance, RAA with left anterior DA arising from the left innominate artery and MI branching, not forming a CVR, was found. Twelve (26.7%) fetuses had a congenital heart defect (CHD). RAA forming a CVR (U-shaped appearance) was associated with a septal defect in 6/37 (16.2%) fetuses, while RAA not forming a CVR (V-shaped appearance or no U- or V-shaped appearance) was associated with major CHD in 6/8 (75.0%) fetuses. CONCLUSIONS In fetuses with RAA, V-shaped appearance of the junction between the DA and AA indicates only that the transverse AA and DA run together on the same side of the thorax (trachea) while a U-shaped appearance is always a sign of a CVR. Among fetuses with a CVR, RAA/LPDA/MI is more frequent than described previously. Finally, RAA forming a CVR is not usually associated with complex CHD, as opposed to RAA not forming a CVR. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C M Campanale
- Division of Perinatal Cardiology, Department of Medical and Surgical Neonatology, Ospedale Pediatrico 'Bambino Gesù', Rome, Italy
| | - L Pasquini
- Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Pediatrico 'Bambino Gesù', Rome, Italy
| | - T P Santangelo
- Department of Radiology, Ospedale Pediatrico 'Bambino Gesù', Rome, Italy
| | - F S Iorio
- Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Pediatrico 'Bambino Gesù', Rome, Italy
| | - P Bagolan
- Division of Neonatal Surgery, Department of Medical and Surgical Neonatology, Ospedale Pediatrico 'Bambino Gesù', Rome, Italy
| | - S P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - A Toscano
- Division of Perinatal Cardiology, Department of Medical and Surgical Neonatology, Ospedale Pediatrico 'Bambino Gesù', Rome, Italy
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Sagi-Dain L, Singer A, Josefsberg S, Peleg A, Lev D, Samra NN, Bar-Shira A, Zeligson S, Maya I, Ben-Shachar S. Microarray analysis has no additional value in fetal aberrant right subclavian artery: description of 268 pregnancies and systematic literature review. Ultrasound Obstet Gynecol 2019; 53:810-815. [PMID: 30584678 DOI: 10.1002/uog.20208] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 11/29/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Fetal aberrant right subclavian artery (ARSA) is a relatively common sonographic finding. Several studies have reported a significant association between ARSA and Down syndrome, as well as 22q11.2 microdeletion. The objective of this study was to assess the risk of abnormal chromosomal microarray analysis (CMA) findings in a large cohort of pregnancies with fetal ARSA as an isolated, as well as a non-isolated, sonographic anomaly. A secondary objective was to review the literature, examining the frequency of chromosomal microarray aberrations in fetuses with isolated ARSA. METHODS Data from all pregnancies referred for invasive testing and CMA due to sonographic diagnosis of fetal ARSA, between 2013 and 2017, were obtained retrospectively from the computerized database of the Israeli Ministry of Health. The rate of clinically significant CMA findings in these fetuses was compared to that in a local control population of 2752 low-risk pregnancies with normal ultrasound and serum screening results. In addition, a literature search was conducted in PubMed, from inception to February 2018, of original studies in the English language describing the frequency and nature of microscopic and submicroscopic aberrations in fetuses with isolated ARSA. RESULTS Of 246 pregnancies with isolated ARSA that underwent CMA analysis, a clinically significant finding was detected in one (0.4%) pregnancy (trisomy 21). This rate did not differ significantly from that in the control population (P = 0.1574). Of 22 fetuses with non-isolated ARSA, one (4.5%) additional case of trisomy 21 was noted. The frequency of trisomy 21 in this cohort also did not differ from that in the control population (relative risk, 5.5 (95% CI, 0.8-37.6)). The literature search yielded 13 additional relevant papers, encompassing 333 cases of isolated ARSA. Of 579 cases overall (including those of the present study), 13 (2.2%) cases of trisomy 21 were detected, with no cases of 22q11.2 microdeletion. CONCLUSION While an association may exist between non-isolated ARSA and Down syndrome, isolated ARSA might better serve as a soft marker for Down syndrome, rather than a routine indication for invasive prenatal testing. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L Sagi-Dain
- Genetics Institute, Carmel Medical Center, affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - A Singer
- Community Genetics, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - S Josefsberg
- Genetics Institute, Kaplan Medical Center, Rehovot, Israel
| | - A Peleg
- Genetics Institute, Carmel Medical Center, affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - D Lev
- The Rina Mor Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
| | - N Nasser Samra
- Institute of Human Genetics, Ziv Medical Center, Safed, Israel
| | - A Bar-Shira
- The Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Zeligson
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - I Maya
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - S Ben-Shachar
- The Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rizza A, De Caterina AR, Murzi M, Farneti PA, Palmieri C, Berti S. Double Carotid-Subclavian Bypass Followed by Endovascular Exclusion of a Kommerell Diverticulum and Bilateral Subclavian Artery Occlusion in a Right-Sided Aortic Arch. JACC Cardiovasc Interv 2019; 12:e81-e82. [PMID: 30981575 DOI: 10.1016/j.jcin.2019.01.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/02/2019] [Accepted: 01/08/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Antonio Rizza
- Ospedale del Cuore, Fondazione Toscana "G. Monasterio," Massa, Italy
| | | | - Michele Murzi
- Ospedale del Cuore, Fondazione Toscana "G. Monasterio," Massa, Italy
| | | | - Cataldo Palmieri
- Ospedale del Cuore, Fondazione Toscana "G. Monasterio," Massa, Italy
| | - Sergio Berti
- Ospedale del Cuore, Fondazione Toscana "G. Monasterio," Massa, Italy
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Tateyama M, Konno M, Takano R, Chida K, Rikimaru H, Chida K. A Computed Tomographic Assessment of Tracheostomy Tube Placement in Patients with Chronic Neurological Disorders: The Prevention of Tracheoarterial Fistula. Intern Med 2019; 58:1251-1256. [PMID: 30626805 PMCID: PMC6543219 DOI: 10.2169/internalmedicine.1158-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Tracheoarterial fistula (TAF) is a rare but devastating complication of tracheostomy caused by pressure necrosis from the elbow, tip, or over-inflated cuff of the tracheostomy tube. The incidence of TAF is reportedly higher in patients with neurological disorders than in those without such disorders. To evaluate the incidence of and factors contributing to the misalignment of tracheostomy tubes in bedridden patients with chronic neurological disorders. Methods We retrospectively assessed three-dimensionally reconstructed serial computed tomography (CT) images to see if the tip of the tube made contact with the tracheal wall and if the main arteries were running adjacent to the tube's elbow, tip or cuff. Results The tip of the tube was in contact with the tracheal wall in 14 of the 30 patients assessed. Among them, the tip was adjacent to the innominate artery in eight, the aortic arch in three and an aberrant right subclavian artery in one. In one patient with the tube tip adjacent to the aortic arch and the other four patients, the cuff of the tube was adjacent to the innominate artery across the tracheal wall. Patients with the tube tip in contact with the anterior tracheal wall had a significantly greater cervical lordosis angle than those without contact (p<0.05). Conclusion More than half of tracheostomized patients with chronic neurological disorders had a latent risk of TAF. The variability in the location of the innominate artery, anomalies of the aortic arch, and skeletal deformities may therefore be contributing factors.
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Affiliation(s)
- Maki Tateyama
- Department of Neurology, National Hospital Organization Iwate Hospital, Japan
| | - Masatoshi Konno
- Department of Neurology, National Hospital Organization Iwate Hospital, Japan
| | - Rina Takano
- Department of Neurology, National Hospital Organization Iwate Hospital, Japan
| | - Koichi Chida
- Department of Neurology, National Hospital Organization Iwate Hospital, Japan
| | - Hiroya Rikimaru
- Department of Radiology, National Hospital Organization Sendai Medical Center, Japan
| | - Keiji Chida
- Department of Neurology, National Hospital Organization Iwate Hospital, Japan
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Lee M, Moharem-Elgamal S, Beckingham R, Hamilton M, Manghat N, Milano EG, Bucciarelli-Ducci C, Caputo M, Biglino G. Evaluating 3D-printed models of coronary anomalies: a survey among clinicians and researchers at a university hospital in the UK. BMJ Open 2019; 9:e025227. [PMID: 30852545 PMCID: PMC6430025 DOI: 10.1136/bmjopen-2018-025227] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of three-dimensional (3D) printing models of coronary artery anomalies based on cardiac CT data and explore their potential for clinical applications. DESIGN Cardiac CT datasets of patients with various coronary artery anomalies (n=8) were retrospectively reviewed and processed, reconstructing detailed 3D models to be printed in-house with a desktop 3D printer (Form 2, Formlabs) using white resin. SETTING A University Hospital (division of cardiology) in the UK. PARTICIPANTS The CT scans, first and then 3D-printed models were presented to groups of clinicians (n=8) and cardiovascular researchers (n=9). INTERVENTION Participants were asked to assess different features of the 3D models and to rate the models' overall potential usefulness. OUTCOME MEASURES Models were rated according to clarity of anatomical detail, insight into the coronary abnormality, overall perceived usefulness and comparison to CT scans. Assessment of model characteristics used Likert-type questions (5-point scale from 'strongly disagree' to 'strongly agree') or a 10-point rating (from 0, lowest, to 10, highest). The questionnaire included a feedback form summarising overall usefulness. Participants' imaging experience (in a number of years) was also recorded. RESULTS All models were reconstructed and printed successfully, with accurate details showing coronary anatomy (eg, anomalous coronary artery, coronary roofing or coronary aneurysm in a patient with Kawasaki syndrome). All clinicians and researchers provided feedback, with both groups finding the models helpful in displaying coronary artery anatomy and abnormalities, and complementary to viewing 3D CT scans. The clinicians' group, who had substantially more imaging expertise, provided more enthusiastic ratings in terms of models' clarity, usefulness and future use on average. CONCLUSIONS 3D-printed heart models can be feasibly used to recreate coronary artery anatomy and enhance understanding of coronary abnormalities. Future studies can evaluate their cost-effectiveness, as well as potentially explore other printing techniques and materials.
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Affiliation(s)
- Matthew Lee
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Moharem-Elgamal
- National Heart Institute, Giza, Egypt
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | | | - Mark Hamilton
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Nathan Manghat
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Elena Giulia Milano
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Giovanni Biglino
- Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Mrochek AG, Kabak SL, Haidzel IK, Melnichenko YM, Kalenchic TI. Coexistence an aberrant right subclavian artery with other congenital anomalies: case report and review of the literature. Surg Radiol Anat 2019; 41:963-967. [PMID: 30737539 DOI: 10.1007/s00276-019-02206-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/01/2019] [Indexed: 12/30/2022]
Abstract
Aberrant right subclavian artery is the most common aortic arch anomaly that frequently occurs in coexistence with other congenital cardiovascular anomalies. A 32-year-old male patient was hospitalized with ventricular septal defect, chronic heart failure NYHA class III, pulmonary arterial hypertension. Contrast-enhanced multislice computed tomography revealed membranous ventricular septal defect, persistent left superior vena cava, bicuspid aortic valve and aberrant right subclavian artery. Aberrant right subclavian artery was clinically silent and discovered accidentally. The patient underwent heart-lung transplantation due to pronounced, irreversible pulmonary hypertension. This article reports a rare coexistence of aberrant right subclavian artery with other congenital anomalies of the heart and great vessels in living men.
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Affiliation(s)
| | - Sergey Lvovich Kabak
- Human Morphology Department, Belarusian State Medical University, Minsk, Belarus
| | | | | | - Tamara Ivanovna Kalenchic
- Medical Rehabilitation and Physiotherapy Department, Belarusian State Medical University, Minsk, Belarus
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Dong SZ, Zhu M. MR imaging of subaortic and retroesophageal anomalous courses of the left brachiocephalic vein in the fetus. Sci Rep 2018; 8:14781. [PMID: 30283087 PMCID: PMC6170443 DOI: 10.1038/s41598-018-33033-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 09/19/2018] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to report fetal cases of subaortic and retroesophageal anomalous courses of the left brachiocephalic vein (LBCV) evaluated by fetal cardiac magnetic resonance imaging (MRI). A retrospective review of 7282 fetal cardiac MRI from June 2006 to March 2017, nine cases of anomalous courses of the LBCV were correctly diagnosed by fetal cardiac MRI, one case of abnormal subaortic left brachiocephalic vein (ASLBV) missed by fetal MRI was identified postnatally during further imaging of the TOF. The diagnosis was confirmed postnatally by cardiac CT/MRI. An ASLBV was found in 8 cases, a retroesophageal LBCV was found in 2 additional cases with right aortic arch and aberrant left subclavian artery. 3 of 8 ASLBV cases were with a right aortic arch, 4 ASLBV cases had additional cardiovascular anomalies with one case isolated. 7 of 8 ASLBV and 2 retroesophageal LBCV were correctly diagnosed by fetal cardiac MRI; however fetal cardiac MRI missed 2 cases of associated pulmonary atresia (PA). Prenatal echocardiography (echo) correctly diagnosed five ASLBV and one retroesophageal LBCV as well as associated intracardiac anomalies. Fetal cardiac MRI can be a useful adjunct in the identification of subaortic and retroesophageal anomalous courses of the LBCV prenatally.
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Affiliation(s)
- Su-Zhen Dong
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Ming Zhu
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China.
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Guo H, Sun X, Yu C, Shu C. A case report of frozen elephant trunk combined with endovascular treatment for acute aortic dissection of Kommerell's diverticulum involving right aortic arch and descending aorta. Medicine (Baltimore) 2018; 97:e0166. [PMID: 29642141 PMCID: PMC5908621 DOI: 10.1097/md.0000000000010166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Acute aortic dissection of Kommerell's diverticulum in the right aortic arch is extremely rare. There are several different procedures for the disease. With advances in endovascular treatment, hybrid surgical and endovascular management may provide a treatment of choice for this kind of disease. PATIENT CONCERNS A 43-year-old man was admitted to the hospital with intermittent pain of left arm, chest, and back. DIAGNOSES Computed tomography demonstrated an aberrant left subclavian artery originating from Kommerell's diverticulum in the right aortic arch, acute aortic dissection of Kommerell's diverticulum involving arch and descending aorta. INTERVENTIONS Total arch replacement combined with frozen elephant trunk was performed to create an adequate landing zone through a median sternotomy by circulatory arrest. Thoracic endovascular aortic repair was performed to isolate Kommerell's diverticulum from descending aorta completely, extending from the frozen elephant trunk to the distal descending aorta at the same time. OUTCOMES The patient got an uneventful postoperative course. LESSONS Hybrid surgical and endovascular management is a safe and effective procedure for this rare disease.
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Beloosesky R, Shrim A, Steinberg M, Khatib N, Bronshtein M. Isolated aberrant right subclavian artery at 14-16 weeks of gestation and Down syndrome. J Clin Ultrasound 2018; 46:62-63. [PMID: 29080315 DOI: 10.1002/jcu.22543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/22/2017] [Accepted: 08/25/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Alon Shrim
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Maya Steinberg
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Moshe Bronshtein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
- Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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Leite GC, Ururahy MA, Bezerra JF, Lima VM, Costa MI, Freire SS, Luchessi AD, Maia JM, Brito ME, Gil-da-Silva-Lopes VL, Rezende AA. Cardiovascular abnormalities in patients with oral cleft: a clinical-electrocardiographic-echocardiographic study. Clinics (Sao Paulo) 2018; 73:e108. [PMID: 29694606 PMCID: PMC5890169 DOI: 10.6061/clinics/2018/e108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/16/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The present study aims to describe the clinical, electrocardiographic, and echocardiographic cardiological findings in a group of patients with oral clefts. METHODS This is a prospective cross-sectional study on 70 children (age range from 13 days to 19 years) with oral clefts who attended the multidisciplinary program of a university hospital from March 2013 to September 2014. The patients were evaluated by a pediatric cardiologist and underwent detailed anamnesis, physical examination, electrocardiogram, and echocardiogram. RESULTS Sixty percent of the patients were male; 55.7% presented with cleft lip and palate, and 40.0% presented with health complaints. Comorbidities were found in 44.3%. Relevant pregnancy, neonatal, family and personal antecedents were present in 55.7%, 27.1%, 67.2%, and 24.3% of the patients, respectively. Regarding the antecedents, 15.2% of the patients presented with a cardiac murmur, 49.0% with a familial risk of developing plurimetabolic syndrome, and 6% with family antecedents of rheumatic fever. Electrocardiographic evaluation showed one case of atrioventricular block. Echocardiograms were abnormal in 35.7% of the exams, including 5 cases of mitral valve prolapse - one of which was diagnosed with rheumatic heart disease. CONCLUSION The finding of a family risk of developing plurimetabolic syndrome and a diagnosis of rheumatic heart disease indicates that patients with oral clefts may be more prone to developing acquired heart disease. Thus, our findings highlight the importance of anamnesis and methodological triangulation (clinical-electrocardiographic-echocardiographic) in the investigation of patients with oral clefts and emphasize that cardiological follow-up to evaluate acquired and/or rhythm heart diseases is necessary. This strategy permits comorbidity prevention and individualized planned treatment.
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Affiliation(s)
- Gisele C.P. Leite
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Marcela A.G. Ururahy
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - João F. Bezerra
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Valéria M.G.D.M. Lima
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Maria I.F. Costa
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Sandra S.C. Freire
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - André D. Luchessi
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Jussara M.C. Maia
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Maria E.F. Brito
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | | | - Adriana A. Rezende
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
- Corresponding author. E-mail:
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Chaudhry NA, Zahid K, Keihanian S, Dai Y, Zhang Q. Transmitted cardiovascular pulsations on high resolution esophageal impedance manometry, and their significance in dysphagia. World J Gastroenterol 2017; 23:7840-7848. [PMID: 29209125 PMCID: PMC5703913 DOI: 10.3748/wjg.v23.i44.7840] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/08/2017] [Accepted: 09/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the behavior of pulsatile pressure zones (PPZ’s) as noted on high resolution esophageal impedance manometry (HREIM), and determine their association with dysphagia.
METHODS Retrospective, single center case control design screening HREIM studies for cases (dysphagia) and controls (no dysphagia). Thoracic radiology studies were reviewed further in cases for (thoracic cardiovascular) thoracic cardiovascular (TCV) structures in esophageal proximity to compare with HREIM findings. Manometric data was collected for number, location, axial length, PPZ pressure and esophageal clearance function (impedance).
RESULTS Among 317 screened patients, 56% cases and 64% controls had PPZ’s. Fifty cases had an available thoracic radiology comparison. The distribution of PPZ’s in these 50 cases and 59 controls was similar (average 1.4 PPZ/patient). Controls (mean 31.2 ± SD 12 years) were a significantly younger population than cases (mean 67.3 ± SD 14.9 years) with P < 0.0001. The upright posture PPZ pressure was higher in controls (15.7 ± 10.0 mmHg) than cases (10.8 ± 9.7 mmHg). Although statistically significant (P = 0.005), it was a weak predictor using logistic regression and ROC model (AUC = 0.65). Three dysphagia patients had partial compression from external TCV on radiology (1 aberrant subclavian artery, 2 dilated left atrium). The posture (supine vs upright) with more prominent PPZ’s impaired bolus clearance in 9 additional cases by > 20%.
CONCLUSION Transmitted TCV pulsations observed in HREIM bear no significant impact on swallowing. However, in older adults with dysphagia, evidence of impaired bolus clearance on impedance should be evaluated for external TCV compression. These associations have never been explored previously in literature, and are novel.
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Affiliation(s)
- Naueen A Chaudhry
- Department of Medicine, Division of Gastroenterology, University of Florida, Gainesville, FL 32610, United States
| | - Kamran Zahid
- Department of Medicine, Division of Hospital Medicine, University of Florida, Gainesville, FL 32610, United States
| | - Sara Keihanian
- Department of Medicine, Division of Gastroenterology, University of Florida, Gainesville, FL 32610, United States
| | - Yunfeng Dai
- Department of Biostatistics, University of Florida, Gainesville, FL 32610, United States
| | - Qing Zhang
- Department of Medicine, Division of Gastroenterology, University of Florida, Gainesville, FL 32610, United States
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Moorthy N, Ananthakrishna R, Rao DPV, Hegde M, Nanjappa MC. Right Aortic Arch With Left-Sided Arteria Lusoria: A Challenge for Radial Interventionalists. JACC Cardiovasc Interv 2017; 10:e85-e86. [PMID: 28412259 DOI: 10.1016/j.jcin.2017.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Nagaraja Moorthy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
| | - Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Dattatreya P V Rao
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Madhav Hegde
- Department of Radiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Manjunath C Nanjappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
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Gursoy Erzincan S, Karamustafaoglu Balci B, Tokgoz C, Kalelioglu IH. Incidence of an Aberrant Right Subclavian Artery on Second-Trimester Sonography in an Unselected Population. J Ultrasound Med 2017; 36:1015-1019. [PMID: 28258603 DOI: 10.7863/ultra.16.05075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to assess the incidence of an aberrant right subclavian artery (ARSA) among an unselected population during second-trimester sonography and to review the importance of this conotruncal variant as a marker of Down syndrome. METHODS The presence or absence of an ARSA was assessed in an unselected population of 1913 second-trimester fetuses. RESULTS Among the 1913 patients, an ARSA was detected in 20 fetuses (1.04%), all with a normal karyotype. Thirteen of 20 fetuses had an isolated ARSA, and 7 of them were nonisolated. Associated abnormal sonographic findings were an intracardiac echogenic focus (n = 3), a choroid plexus cyst (n = 1), pyelectasis (n = 1) and tetralogy of Fallot (n = 2). One of the cases of tetralogy of Fallot was also associated with a persistent left superior vena cava, a persistent right umbilical vein, hydrocephalus, rhombencephalosynapsis, and unilateral renal agenesis. There were only 2 fetuses with Down syndrome in this group, and both of them had a normal origin of the right subclavian artery. CONCLUSIONS In an unselected population, an ARSA may be seen less frequently than in a high-risk population and may not be related to Down syndrome. An isolated ARSA is not a sufficient indication for karyotype analysis; it can be managed with noninvasive prenatal testing rather than invasive testing.
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Affiliation(s)
- Selen Gursoy Erzincan
- Department of Obstetrics and Gynecology, Isparta Egirdir Bone Joint Disease and Rehabilitation Hospital, Isparta, Turkey
| | | | - Cengiz Tokgoz
- Department of Obstetrics and Gynecology, Bilge Hospital, Istanbul, Turkey
| | - Ibrahim Halil Kalelioglu
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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50
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Harris DG, Huffner ME, Croal-Abrahams L, DiChiacchio L, Farivar BS, Ayers JD, Toursavadkohi S, Rabin J, Crawford RS. Thoracic Endovascular Repair of Blunt Thoracic Aortic Injury in the Setting of an Aberrant Right Subclavian Artery. Ann Vasc Surg 2017; 42:302.e15-302.e20. [PMID: 28390914 DOI: 10.1016/j.avsg.2016.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022]
Abstract
Blunt thoracic aortic injury (BTAI) in a patient with an aberrant right subclavian artery (ARSA) presents unique challenges for patient management and aortic repair. Specific considerations include the need to treat coincidental ARSA, subclavian revascularization, and ARSA exclusion. Despite the rise of endovascular repair as the primary modality for aortic repair for BTAI, reports of this technique in the setting of ARSA are limited. Here we describe 3 patients with ARSA who underwent TEVAR for BTAI, and discuss critical management and technical issues in these patients.
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Affiliation(s)
- Donald G Harris
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Michael E Huffner
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Luqman Croal-Abrahams
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Laura DiChiacchio
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Behzad S Farivar
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Joseph D Ayers
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, MD
| | - Joseph Rabin
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Robert S Crawford
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, MD.
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