Aberrant right subclavian artery with atrial septal defect: Simultaneous repair via median sternotomy

Arteria Lusoria With Right-Sided Aortic Arch and Atrial Septal Defect Associated With Extensive Thrombosis and Paradoxical Embolism: A Case Report

“…Commonly, arteria lusoria courses behind the esophagus to reach the right arm. Consequently, it may produce symptoms of dysphagia, dyspnea, chest pain, or chronic cough in a minority of patients (7-10%) [ 1 , 2 ]. Additionally, ARSA may be associated with the presence of other vascular anomalies such as septal defects (28%), truncus bicaroticus (19.2%), Kommerell's diverticulum (aneurysmal dilation of the descending aorta at the origin of an aberrant subclavian artery) (14.9%), aneurysms (12.8%), and right-sided aortic arches (9.2%) [ 2 , 3 ].…”

“…Consequently, it may produce symptoms of dysphagia, dyspnea, chest pain, or chronic cough in a minority of patients (7-10%) [ 1 , 2 ]. Additionally, ARSA may be associated with the presence of other vascular anomalies such as septal defects (28%), truncus bicaroticus (19.2%), Kommerell's diverticulum (aneurysmal dilation of the descending aorta at the origin of an aberrant subclavian artery) (14.9%), aneurysms (12.8%), and right-sided aortic arches (9.2%) [ 2 , 3 ]. In our patient, immobility-induced venous, pulmonary, arterial, and paradoxical systemic thrombosis and embolism led to the incidental discovery of arteria lusoria, a right-sided aortic arch, and atrial septal defect.…”

“…Consequently, more recent literature seems to favor the approach of a median sternotomy (vertical inline incision of the sternum) over the performance of a left or right posterolateral thoracotomy due to its improved success rates and lower risk of complications [ 8 ]. For instance, in a prior case report of a two-year-old child who presented with arteria lusoria and an ostium Secundum atrial septal defect, a median sternotomy approach, as opposed to a left thoracotomy or right supraclavicular incision, was used [ 2 ]. Another case report by Rathnakar and colleagues, in which a four-year-old girl was found to have an ARSA and a large ostium Secundum atrial septal defect, further supported a median sternotomy approach due to improved visualization of the original and new implantation sites.…”

“…Due to this distal origin, the right subclavian artery often courses behind the esophagus to reach the right arm [ 1 ]. Although individuals are often asymptomatic (90-93%), they can present with dysphagia, chest pain, and chronic cough [ 2 ]. Arteria lusoria can also be associated with other cardiac defects, including septal defects (28%) and a right-sided aortic arch (9.2%) [ 2 , 3 ].…”

“…Although individuals are often asymptomatic (90-93%), they can present with dysphagia, chest pain, and chronic cough [ 2 ]. Arteria lusoria can also be associated with other cardiac defects, including septal defects (28%) and a right-sided aortic arch (9.2%) [ 2 , 3 ]. Prior literature describing an aberrant right subclavian artery with a left aortic arch and an aberrant left subclavian artery with a right aortic arch is well documented [ 4 ].…”