Reply: Aberrant right subclavian artery and fluoroscopy in the dissection laboratory

Abstract

We thank Dr. Muresian (2011) for his complimentary critique of our article (Vogt et al., 2011) and his comments that extend the discussion of this anatomical variation. He emphasizes the fact that an aberrant right subclavian artery does not have a singular appearance in all individuals but rather can have a range of diameters, a variety of courses, and an appearance that can change over time, as in the evolving pathology of atherosclerosis. He cites references for each of these facts.Since we submitted our report, we have discovered another instance of an aberrant right subclavian artery in the teaching laboratory. We were prepared this time to search for some of the accompanying anatomical variations that Dr. Muresian mentions in his letter, for example, a right-sided termination of the thoracic duct, a bicuspid aortic valve, and aberrant branching of the vertebral arteries. It was clear to the students that the discovery and study of anatomical variations in the laboratory allow them to extend their observations and to take fuller advantage of the rich learning experience of dissection and of the gift to the students of their ''first patient.''Over the years that we have been teaching anatomy in the dissection laboratory, we hear less frequently the complaint from students that the anatomy they are uncovering in their dissections does not match that seen in their anatomical atlases. We attribute this change to an expectation, set by us as instructors early in the course, that variation is to be anticipated and something to be deciphered as a problem-solving exercise.Dr. Muresian concludes his letter with a comment that the comparison we made between data from the patient's previous medical records and information obtained through dissection and other postmortem studies attach even greater value to the donor's gift and to the experience of student dissection. As personalized health care becomes the standard of care, and treatment is tailored to the individual's unique anatomy and genomics, dissection-coupled with history taking through the donor's family and reference to medical records-helps to prepare students to approach each of their future patients as a unique individual. We agree fully with Dr. Muresian's comment that ''... implementation of such programs on a larger scale, would greatly contribute to the development of the medical sciences.' ' We add here that because of the unique and extended relationship we had with the donor who was the case study in our article, we took the opportunity to personally deliver the cremated remains to the family, thus bringing a personal element of closure to the family and us.