• Journal of Korean Neurosurgical Society
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• v.62 no.2
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• pp.175-182
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• 2019

Objective : Aberrant right subclavian artery (ARSA) is a rare anatomical variant of the origin of the right subclavian artery. ARSA is defined as the right subclavian artery originating as the final branch of the aortic arch. The purpose of this study is to determine the prevalence and the anatomy of ARSA evaluated with computed tomography (CT) angiography. Methods : CT angiography was performed in 3460 patients between March 1, 2014 and November 30, 2015 and the results were analyzed. The origin of the ARSA, course of the vessel, possible inadvertent ARSA puncture site during subclavian vein catheterization, Kommerell diverticula, and associated vascular anomalies were evaluated. We used the literature to review the clinical importance of ARSA. Results : Seventeen in 3460 patients had ARSA. All ARSAs in 17 patients originated from the posterior aspect of the aortic arch and traveled along a retroesophageal course to the right thoracic outlet. All 17 ARSAs were located in the anterior portion from first to fourth thoracic vertebral bodies and were located near the right subclavian vein at the medial third of the clavicle. Only one of 17 patients presented with dysphagia. Conclusion : It is important to be aware ARSA before surgical approaches to upper thoracic vertebrae in order to avoid complications and effect proper treatment. In patients with a known ARSA, a right transradial approach for aortography or cerebral angiography should be changed to a left radial artery or transfemoral approach.

• Korean Journal of Veterinary Research
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• v.64 no.2
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• pp.11.1-11.5
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• 2024

A 4-month-old intact male Sapsaree dog was referred due to a history of postprandial regurgitation following consumption of solid food. Thoracic radiography revealed focal leftward displacement of the thoracic trachea at T1 to T4 vertebrae levels. Barium contrast radiography revealed focal dilation of the cranial thoracic esophagus at the heart base level. Persistent right aortic arch (PRAA) with an aberrant left subclavian artery branching from the patent ductus arteriosus was diagnosed by computed tomography angiography (CTA). Although barium contrast radiography can presumptive diagnose PRAA, CTA should be considered for identifying additional vascular anomalies, specific types, and surgical planning.

• Journal of Chest Surgery
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• v.34 no.7
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• pp.547-551
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• 2001

The effects of deep hypothermia and circulatory arrest during aortic arch reconstruction are associated with potential neurologic and myocardial injury. We describe a surgical technique that two patients underwent a modified Norwood procedure without circulatory arrest and myocardial ischemia. One was 13-day-old female patient, weighing 3.1kg, having a variant of hypoplastic left heart syndrome and another was 38-day-old male patient, weighing 3.4 kg, diagnosed Taussig-Bing anomaly with severe aortic arch hypoplasia, coarctation of the aorta, and subaortic stenosis. The arterial cannula was inserted in innominate artery directly. During Norwood reconstruction, regional high-flow perfusion into the inominate artery and coronary perfusion were maintained and there were no neurologic, cardiac, and renal complications in two patients. This technique may help protect the brain and myocardium from ischemic injury in patients with hypoplastic left heart syndrome or other arch anomalies including coarctation or interruption.

• Clinical and Experimental Pediatrics
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• v.52 no.8
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• pp.910-916
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• 2009

Purpose : The arterial switch operation (ASO) has become the preferred procedure for the surgical management of transposition of the great arteries (TGA). We conducted a retrospective evaluation of our experience in 30 patients seen from January 2003 to July 2008, in order to determine outcomes and related risk factors after the arterial switch operation. Methods : Patients charts, surgical reports, and echocardiograms were retrospectively reviewed. And they were analyzed in 2 different groups: complex (n=16) versus simple TGAs (n=14). Complex TGAs are TGAs with VSD or the Taussig-Bing anomaly with or without aortic arch anomalies. Simple TGAs are defined as TGAs with intact ventricular septum having no such anomalies. Median follow-up time was 44 months (3-63 months). Results : Hospital mortality was 0%. However, follow-up echocardiographies revealed potential complications, including stenosis of the branch pulmonary arteries, neo-aortic and/or neo-pulmonary valvar regurgitation, and right or left ventricular outflow tract obstructions. Great arterial relationship (side-by-side), association of aortic arch anomalies, and the existence of the Taussig- Bing anomaly were assessed as significant risk factors of neo-aortic and/or neo-pulmonary valvar regurgitation in this series. On the other hand, right or left ventricular outflow tract obstructions were more frequently found in patients demonstrating VSD, side-by-side positioned great arteries, or associated coronary anomalies. Conclusion : The ASO is the procedure of choice in the treatment of TGA. However, special attention and follow-ups are needed to detect residual problems like the stenosis of the branch pulmonary arteries, neo-aortic and/or neo-pulmonary valvar regurgitation, as well as ventricular outflow tract obstructions.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.434-439
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• 2006

Background: Deep hypothermic circulatory arrest during repair of aortic arch anomalies may induce neurological complications or myocardial injury. So we surveyed if the regional cerebral and myocardial perfusion might eliminate those potential side effects. Material and Method: From March 2000 to December 2004, 62 neonates or infants with aortic arch anomaly underwent one stage biventricular repair using the regional perfusion technique by single surgeon. Preoperative diagnosis of the arch anomaly consisted of coarctation (n=46), interruption of the aorta (n=12), hypoplastic left heart syndrome (n=2) and truncus areteriosus (n=2). Combined anomalies were ventricular septal defect (n=51), TAPVR (n=1), PAPVR (n=1) and atrioventricular septal defect (n=2). Arterial cannula was inserted at the innominate artery. Result: The mean regional perfusion time of brain was $28{\pm}10min$. Operative mortality rates was 0 (0/62). Late death was 1 (1/62) during $11{\pm}7$ months of follow-up. Neurologic complications consisted of transient chorea in 1 case. There was no reoperation associated with arch anolamy. Pulmonary complication associated with arch repair occurred in f case which was managed by aortopexy. Conclusion: One-tage rch repair using the regional profusion is safe and effective in minimizing the neurologic and myocardial complications.

• Journal of the Korean Society of Radiology
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• v.82 no.4
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• pp.948-952
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• 2021

The absence of the common carotid artery (CCA) and the common origin of the left external carotid artery (ECA) and the right CCA are rare anomalies of the cervical vascular system. We report here a case involving the coexistence of these vascular anomalies with an aberrant right subclavian artery, which is a common congenital anomaly in the aortic arch, and review the embryologic mechanism and clinical importance of this case.

• Journal of Chest Surgery
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• v.27 no.11
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• pp.893-901
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• 1994

Forty nine patients [M: 31, F: 18], age from 2 months to 17 years [mean= 4.9 years], underwent operations, from April 1986 to December 1992, for the relief of subvalvular aortic stenosis in normal atrioventricular and ventriculoarterial connections.There were 4 anatomic types of subaortic stenosis : membranous in 29 cases [59.2%], fibromuscular in 11 [22.4%], diffuse tunnel type in 7 [14.3%], and miscellaneous in 2 cases. Thirty four patients [69.4%] had associated cardiac anomalies, of which ventricular septal defect was the most common [27 cases]. Other anomalies were patent ductus arteriosus, coarctation of the aorta, valvular aortic stenosis, double chambered right ventricle [DCRV], infundibular pulmonic stenosis, persistent left superior vena cava, and rigt aortic arch. Mean systolic pressure gradient between the left ventricle and ascending aorta was 26.4$\pm$17.6 mmHg : 13.1$\pm$17.6mmHg in the membranous type, 22.0$\pm$18.4mmHg in the fibromucular type, and 56.1$\pm$38.4mmHg in the diffuse tunnel type. Operative procedures were determined according to the type of subvalvular aortic stenosis : simple excision of subaortic membrane in the membranous type [29 cases], left ventricular myectomy with or without myotomy or fibrous tissue excision in the fibromuscular type [11 cases]. Among the 7 of diffuse tunnel type cases, ventricular myectomy was performed in 2 and a modified Konno operation was performed in 5 . Postoperative follow up was made with periodic echocardiography. The Mean postoperative follow up period was 33.8 months. There were 2 hospital mortalities [4.1%] and 2 late deaths. Residual stenosis remained in 3 cases and recurrence developed in 2 cases during the follow up period. 5 years actuarial survival rate was 91.8$\pm$3.9% and 5 year complication free rate was 72.3$\pm$10.4%. Conclusions : 1. Subvalvular aortic stenosis should be relieved completely as soon as possible when diagnosed, regardless of left ventricular outflow tract pressure gradient. 2. Good results were obtained using only simple excision of subaortic membrane in the membranous type of subaortic stenosis. However, aortoventriculoplasty [modified Konno prodedure] was necessary for good results in the diffuse tunnel type. 3. Periodic postoperative echocardiography was helpful in detecting the progression of residual stenosis and development of new stenosis.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.320-326
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• 1985

Pulmonary sequestration occurs when some disturbance produces a cystic mass of nonfunctioning lung tissue which lacks normal communication with the tracheobronchial tree. Between 1971 and 1985, pulmonary sequestration was diagnosed in 11 patients, ranging age from 3 to 29 years. All sequestration were intralobar type. Definitive diagnosis can only be obtained by aortography and/or surgical exploration in 10 cases. The other one was confirmed by pathologic examination postoperatively. The presenting complaints were mostly recurrent local pulmonary infection, but in 2 cases mediastinal mass with respiratory symptoms was presented, and cardiac murmur was only finding in one case. Preoperative diagnostic procedure revealed 3 associated anomalies which were funnel chest, right aortic arch, and pulmonic stenosis with vascular ring. Operative treatment for sequestration was lobectomy in 10 cases, and a segmentectomy in one. There was no operative mortality, but 3 complications [empyema, B-P fistula, post-op bleeding] which were controlled by subsequent operations or conservative measure. Aortography is strongly advocated not only for its diagnostic value, but for its preoperative localization of the aberrant vessels that are the major concern to the surgeon.

• Journal of Chest Surgery
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• v.23 no.4
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• pp.785-790
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• 1990

A 30-year-old male with a symptomatic aberrant right subclavian artery underwent surgical intervention on January 17, 1990. An aberrant right subclavian artery is a rare congenital anomaly, but it is the most common one of the aortic arch anomalies. This anomalous vessel usually does not produce symptoms, but occasionally symptomatic patients require surgical intervention. Although ligation and division of the aberrant right subclavian artery through left thoracotomy has been advocated by many surgeons, the ischemic symptoms of the upper extremity or the brain can occur. In the procedure described here, ligation and division of the aberrant artery and its anastomosis to the ascending aorta with Gore \ulcornerTex vascular graft was performed simultaneously through midsternotomy. With this procedure, we relieved the esophageal obstruction and established normal blood flow to the right arm. Hoarseness developed postoperatively. We consider that above symptom has been attributed to the injury of the left recurrent laryngeal nerve during dissection.

• Journal of Chest Surgery
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• v.52 no.1
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• pp.55-57
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• 2019

Robotically assisted mitral valve repair has proven its efficacy during the last decade. The most suitable approach for patients with difficult anatomies, such as morbid obesity, sternal deformities, cardiac rotation, or vascular anomalies, represents a current challenge in cardiac surgery. Herein, we present the case of a 71-year-old patient affected by severe degenerative mitral valve regurgitation with pectus excavatum and a right aortic arch with an anomalous course of the left subclavian artery who was successfully treated using a Da Vinci-assisted approach.