High incidence of progressive stenosis in aberrant left subclavian artery with right aortic arch

Abstract

Right aortic arch with aberrant left subclavian artery (RAA/aLSCA) is a rare aortic arch anomaly. The clinical association of aLSCA stenosis with RAA/aLSCA has not yet been fully elucidated. The aim of this study was to investigate the diagnosis, incidence, management and outcome of aLSCA stenosis in infants with prenatally diagnosed RAA/aLSCA. Ten fetuses who were diagnosed as having RAA/aLSCA in Kyushu University Hospital between January 2011 and December 2014 were enrolled. The maternal and child medical records were reviewed to investigate sex, gestational age at the fetal diagnosis, gestational age and body weight at birth, the findings of computed tomography (CT), Doppler ultrasonography of the vertebral artery and angiography, and the complications and outcomes of aLSCA stenosis. In 8 of 10 patients, aLSCA stenosis was identified on the first CT examination after birth. No patients had dysphagia or respiratory distress. The stenosis spontaneously resolved in 3 patients. In 4 of the 5 remaining patients, aLSCA stenosis progressed, including one case in which complete occlusion occurred-the case was associated with retrograde flow from the left vertebral artery supplying the distal LSCA. Balloon angioplasty was successfully used to treat stenosis in two cases. The subclavian steal phenomenon and developmental problems were not observed in any patients. aLSCA stenosis was identified in 80% of patients with RAA/aLSCA after birth. The early detection and elective treatment of stenotic lesions may be required to prevent complete occlusion during the development of the cardiovascular and cerebrovascular systems.

Systematic review and meta-analysis of right subclavian artery variants and their correlation with cervical-thoracic clinical conditions

“…The aforementioned criteria are detailed in Supplementary Table 2, Supplemental Digital Content, http://links.lww.com/MD/L365 and Figure 2. With a total of 39 included studies, for the 27 studies that had an N > 1, [24–50] the following data were collected: the total number of subjects included in the studies was 41,178 with an average ratio of 1.525:1 regarding the sex of the sample; 12 studies did not indicate the sex of their sample [25,27,31,34,35,37,38,45,47–50] ; one study by Yusuf et al [32] only indicates the sex of the sample that did present the anatomical variant and consisted of 10 men and 17 women, respectively; and, finally, 14 studies [24,26,28–30,33,39–44,46] show that the cumulative data for males was 2964/5393, which is equivalent to 54.9%, and cumulative data for females was 2429/5393, which is equivalent to 45.1%. Finally, regarding the geographical distribution of the included studies, [24–50,53–64] in 13 studies, the sample was European, which is equivalent to 33.3% of the included studies; in 12 studies, the sample was from North America, which is equivalent to 30.8% of the included studies; and, finally, 14 studies had a sample from Asia, which is equivalent to 35.9% of the studies included in this review (Table 2).…”

The multiform sonographic spectrum of arterial duct in right aortic arch

“…However, in 6 (26%) cases, weak/absent arterial pulses in the left upper limb were found within the first postnatal months. Prenatally detected proximal stenosis of ALSA has been reported in one case initially [15], then in a series of 10 [16]. Easily missed in early years, this may remain asymptomatic for years then later cause subclavian steal or severe vascular complications [17,18].…”

No Pain and No Gain: Kommerell’s Diverticulum with a Right-Sided Aortic Arch, and an Aberrant Left Subclavian Artery Presenting in a Body Builder with Muscle Bulk Imbalance

“…1 Of this population, right aortic arch with aberrant left subclavian artery is twice as common in men than in females with females more often presenting with left aortic arch with aberrant right subclavian artery. 5 KD anomaly was first discovered by a German radiologist, Burckhard F. Kommerell, in 1936. 6 Most commonly, children will present with breathing difficulties secondary to the development of the trachea and malleable tracheal rings.…”