Left-sided Cervical Aortic Arch Associated With Pseudocoarctation, Aneurysm Formation, and Anomalous Left Brachiocephalic Vein

Khoury, Nabil; Hourani, Roula; Birjawi, Ghina A.; Hourani, Mukbil

doi:10.1097/rti.0b013e318178829c

Cited by 11 publications

(26 citation statements)

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“…Double aortic arch was also observed in 8% of the patients without CHD (Kim et al, 1999;Minami et al, 1993;Tsujimura et al, 2007). Cervical aortic arch was associated with ASLBV in approximately 40% of the patients without CHD (Bartoli et al, 1990;Khoury et al, 2008;Türkvatan et al, 2009;Yama et al, 2005). Thus, in patients without CHD, the proportion of the cases associated with the cervical aortic arch and/or double aortic arch was quite higher than that in patients with CHD.…”

Section: Discussionmentioning

confidence: 74%

Anomalous subaortic left brachiocephalic vein in surgical cases and literature review

et al. 2010

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Anomalous subaortic left brachiocephalic vein (ASLBV) is a rare systemic venous anomaly. We review our experience with patients associated with ASLBV who underwent cardiac surgery at three institutions. From 1989 to 2009, the medical records of surgically treated patients with ASLBV were analyzed; the incidence of ASLBV, clinical characteristics, and associated anatomical findings were assessed. Fifteen patients had ASLBV. All ASLBVs coursed left lateral to the aortic arch, passed under the ascending aorta anterior to the central pulmonary artery, and joined the right brachiocephalic vein. Fourteen patients had congenital heart disease (CHD), and the remaining patient did not have cardiac anomalies. Its incidence was 0.57% (14 of 2,449) in patients with CHD and only 0.02% (1 of 4,805) in patients without CHD. In patients with CHD, 73.3% (11 of 15) of the patients had conotruncal cardiac anomalies such as tetralogy of Fallot, ventricular septal defect with pulmonary atresia, truncus arteriosus, and interruption of the aortic arch. Eight patients had aortic arch anomalies, including right aortic arch and cervical aortic arch. The deletion of chromosomal 22q11.2 was confirmed in two patients, and one patient was diagnosed with DiGeorge syndrome. ASLBV was clinically silent even without any surgical intervention. ASLBV is a very rare anomaly and is highly associated with conotruncal cardiac anomalies and aortic arch anomalies, including right aortic arch and cervical aortic arch. Preoperative diagnosis is important when any surgical interventions are intended, especially, in patients with conotruncal cardiac anomalies.

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Section: Discussionmentioning

confidence: 74%

Anomalous subaortic left brachiocephalic vein in surgical cases and literature review

et al. 2010

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“…In three documented cases an emergency operation due to a rupture of the unknown aneurysm was performed [ 5 – 7 ]. Interscapular pain or back pain like in our first patients’ anamnesis belong to the uncommon symptoms and may lead primarily to the diagnosis of diseases of the vertebral column [ 32 ]. Back pain belongs to the typical symptoms of type B dissection as well, but might not be the first hypothesis in younger patients.…”

Section: Discussionmentioning

confidence: 99%

“…In 13 cases the therapy remained unclear [ 2 , 9 , 15 , 18 , 19 , 32 , 34 – 36 ]. In 27 cases an operation was performed with a more or less precise description of the technique.…”

Section: Discussionmentioning

confidence: 99%

“… A Artificial graft replacement, temporary bypass – Ikonomidis (1999) [ 6 ] M/23 Left hematothorax, emergency A + K Dacron prosthesis, CPB 12th postoperative day Imai (2000) [ 13 ] M/48 Headache, Murmur A + K Dacron prosthesis – Ito (2014) [ 26 ] F/57 hoarseness and dysphagia A + K Prosthesis, LAA reimplantation 28th postoperative day Kame (1982) [ 40 ] F/39 Rupture, emergency A – – Kaul (2013) [ 31 ] M/56 transient loss of consciousness A Prosthesis, LAA ligation 4-year-FU Kazuno (1988) [ 38 ] M/56 ? A Exclusion, extraanatomic bypass – Khoury (2008) [ 32 ] M/53 interscapular pain A + K – – Kumar (1989) [ 35 ] F/37 ? A – – Lorusso (2006) [ 14 ] F/40 neck pulsation during physical activity no conservatively – McCue (1973) [ 15 ] F/11 Pulsating mass in the neck – – – Mitsumori (2008) [ 21 ] F/38 Incidental finding A Prosthesis, LAA and LCA reimplantation 32-month FU Moncada (1974) [ …”

Section: Introductionmentioning

confidence: 99%

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Anomaly of Haughton type D left cervical aortic arch in combination with type B dissection: case report and literature review

Zientara

Schwegler

Attigah

et al. 2018

J Cardiothorac Surg

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BackgroundThe anomaly of cervical aortic arch is a rare phenomenon first described by Reid in 1914 and categorized by Haughton in 1975. The left cervical aortic arch Type D consisting of an ipsilateral descending aorta and coarctation or aneurysmatic formation of the arch demonstrates a complicated form requiring surgical management. Because of its rarity and unspecific symptoms only few cases are documented with the focus on surgical management.Case presentationA 43-year old, asymptomatic woman presented with a mediastinal mass overlapping the aortic arch region in a routine x-ray. For verification, a computed tomography was performed and revealed incidentally a type B dissection originating from an aneurysm of a left cervical arch with a maximum diameter of 6 cm. Because of the huge diameter and the potential risk of rupture, an urgent surgical repair was planned. Surgical access was performed through median sternotomy and an additional left lateral thoracic incision through the fourth intercostal space. Simultaneously to the preparation, partial cardiopulmonary bypass was installed in the left groin. After preparation of the recurrent and phrenic nerve and the supraaortic branches, the descending aorta was clamped. Before the distal anastomosis to a straight graft, we performed a fenestration of the dissection membrane about a length of 5 cm to preserve the perfusion of both lumina. Then, the straight graft was sutured to the proximal part of descending aorta. The left axillary artery originated directly from the aneurysm and was dissected and reimplanted with a separate 8 mm sidegraft to the straight graft between the distal arch and proximal descending aorta. The patient was extubated on first postoperative day and recovered well.ConclusionThe left cervical aortic arch type D is a rare disease, which is prone to aneurysm formation due to abnormal flow patterns and tortuosity of the aorta. The difficulty lays in the identification of the pathology, especially in the physical examination, since a pulsating mass or cervical murmur seem to be the most specific symptoms in the majority of young, female patients. If diagnosed, surgical therapy with resection of the aneurysm and reimplantation of the axillary artery under cardiopulmonary bypass demonstrates the treatment of choice.

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“…3 Diagnosis can usually be made by transthoracic ultrasonography, and is enhanced by saline contrast transthoracic or transesophageal echocardiography. [11][12][13]18,19,[21][22][23][24][25] The ultrasound "window" may be of poor quality in cases of thymic hypoplasia or agenesis. 14 Visualization of the frontal section of the aortic arch allows recognition of the entire course of left brachiocephalic vein.…”

Section: Demographicsmentioning

confidence: 99%

Surgical Management of Lesions encountered in the Setting of the Retroaortic Left Brachiocephalic Vein

Chowdhury

Anderson

Sankhyan

et al. 2021

Preprint

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The present perspective is a synthesis of 80 published investigations in the setting of a retroaortic left brachiocephalic vein, described in 250 patients. Clinical presentation, radiographic findings, ultrasonographic findings, saline contrast echocardiography, computed-tomographic angiocardiography, magnetic resonance imaging, and angiocardiography provided the diagnostic information used to define the disease entity prior to considering the surgical approach to the associated cardiac anomalies. We have also addressed several issues concerning the influence of isomerism, the establishment of diagnosis, and its importance in various surgical and interventional procedures. Although the retroaortic left brachiocephalic vein is asymptomatic, its recognition during clinical investigation should raise the possibility of an association with other malformations, especially right aortic arch, ventricular septal defect, and anomalies of the outflow tracts. We submit that an increased appreciation of this venous anomaly may facilitate surgical planning, endovascular procedures, placement of central venous lines, and transvenous pacemakers.

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Left-sided Cervical Aortic Arch Associated With Pseudocoarctation, Aneurysm Formation, and Anomalous Left Brachiocephalic Vein

Cited by 11 publications

References 10 publications

Anomalous subaortic left brachiocephalic vein in surgical cases and literature review

Anomalous subaortic left brachiocephalic vein in surgical cases and literature review

Anomaly of Haughton type D left cervical aortic arch in combination with type B dissection: case report and literature review

Surgical Management of Lesions encountered in the Setting of the Retroaortic Left Brachiocephalic Vein

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