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Total arch replacement for a distal aortic arch aneurysm with right aortic arch
Keiko Kiokawa1, Kazutomo Goh, Nobuyuki Akasaka
1First Department Surgery and Emergent Medicine, Asahikawa Medical University, Asahikawa-city, Hokkaido, Japan. kiyokawa@asahikawa-med.ac.jp
The Annals of Thoracic Surgery
|January 30, 2007
Summary
A rare aortic arch anomaly, right-sided aortic arch with aberrant left subclavian artery, can be surgically treated via median sternotomy. This approach successfully managed a large aortic arch aneurysm in a 73-year-old patient.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Right-sided aortic arch with aberrant left subclavian artery is a rare congenital anomaly.
- Aneurysms of the distal aortic arch can present with serious complications.
- Surgical management of complex aortic arch pathologies requires careful consideration of surgical approach.
Observation:
- A 73-year-old female presented with an enlarged distal aortic arch aneurysm (70 mm) and mild dysphagia.
- The patient had a rare anatomical variation: right-sided aortic arch with aberrant origin of the left subclavian artery.
- The aneurysm was successfully treated with total aortic arch replacement.
Findings:
- The surgical procedure utilized selective cerebral perfusion via a median sternotomy.
- Reconstruction of four cervical vessels was performed.
- No additional right thoracotomy was necessary, simplifying the surgical approach.
Implications:
- Median sternotomy alone can provide adequate surgical access for complex aortic arch pathologies, including aneurysms in patients with this rare anomaly.
- This case highlights the feasibility and safety of a less invasive surgical approach.
- Minimally invasive techniques in complex aortic surgery may lead to improved patient outcomes and reduced morbidity.
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