Dysphagia Lusoria with atrial septal defect: Simultaneous repair through midline

Abstract

An aberrant right subclavian artery from the descending aorta is almost always reported as an isolated anomaly. We present the case of a four-year-old child with an anomalous origin of the right subclavian artery from the descending aorta, associated with an ostium secundum atrial septal defect. The patient underwent simultaneous repair of both the anomalies through median sternotomy, with implantation of the subclavian artery into the right common carotid artery. We believe that median sternotomy is the optimal surgical approach for the management of these lesions. Other operative approaches are also discussed.

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

“…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. This approach also allows for the possible initiation of cardiopulmonary bypass, which may be imperative if uncontrollable or unexpected bleeding occurs [ 9 , 10 ]. In our case, these studies also highlight the benefit of early surgical intervention not only ensuring patients do not develop symptomatology from ARSA but also preventing complications of the associated vascular anomalies, such as paradoxical embolism.…”

A Rare Case of Esophageal Dysphagia in Children: Aberrant Right Subclavian Artery

“…Surgical approach is indicated when ARSA is symptomatic or has evidence of aneurysm [ 9 ]. Various surgical approaches can be used, each with its own advantages and limitations [ 24 ]. A symptomatic ARSA can be safely repaired through minimally invasive surgery and endovascular techniques, although symptoms do not always regress.…”

Repair of Aberrant Right Subclavian Artery Causing Dysphagia Lusoria via Partial Median Sternotomy

“…Previous reports have described supraclavicular, right or left thoracotomy, and median sternotomy approaches. 2,4–6 We chose a partial median sternotomy approach due to the belief it would provide the optimal exposure for accessing both the base of the right subclavian and the right carotid artery for end-to-side anastomosis. It is important to ensure that the vascular stump is not left too long and there is no persisting ligamentum arteriosum or dysphagia symptoms that may not resolve.…”