Right-sided Aortic Arch with Aberrant Left Subclavian Artery in a Pregnant Female: A Case Report and Literature Review

Abstract

Right-sided aortic arch with aberrant left subclavian artery is a rare variant of vascular anatomy. Three types of right-sided aortic arches are described and classified based on the arrangement of the aortic arch vessels, the presence or absence of congenital heart abnormalities, the relationship of the aortic arch to the trachea and esophagus, as well as the presence or absence of a complete or incomplete vascular ring. On review of the existing literature, 31 case reports were found with a spectrum of clinical presentation sand outcomes. In this case report, we highlight a case of a young female in her early 20'swho presented with choking spells, shortness of breath along with intermittent dysphagia since childhood. She was otherwise healthy and pregnant at 26 weeks gestational age. A Computed tomography scan with angiography (CTA) of the thorax was performed to rule out a pulmonary embolism (PE) however surprisingly, a right-sided aortic arch with aberrant left subclavian artery was revealed instead. Subsequently, an extensive literature review was carried out to better understand clinical presentation sand treatment strategies for this rather rare disorder.

A rare case of symptomatic vascular ring

“…Studying these abnormalities by means of a pulmonary CT-angiographic study is still possible through accurate knowledge of the major abnormalities. In fact, ours is not the first case of anomalies of the arch and epiaortic vessels incidentally discovered through pulmonary CT-angiography in [ 7 , 8 ] thus making it necessary to be aware and able to classify them correctly.…”

Case Report: Successful Treatment of Aberrant Left Subclavian Artery With a Right-Sided Aortic Arch

“…Among these, 11 patients presented with dysphagia, 6 patients were asymptomatic, 2 patients presented with an aortic dissection, 2 with aneurysms, 1 with respiratory symptoms, 1 with cerebrovascular insufficiency, 1 with left upper extremity pain and numbness on exercise, 1 with left cerebral infarction, 1 with a right nonrecurrent laryngeal nerve, 1 with acute superior vena cava syndrome, 1 with pseudo-occlusion of the left internal carotid artery, 1 with subclavian steal syndrome, and 2 with rupture. 4 Literature regarding repair is currently limited to small case series. A review of 9 adult patients undergoing repair demonstrated varying natural history of disease progression.…”

Right-sided aortic arch with complex anomalies presented with transient ischemic attack

“…Based on a literature review of adult cases with Type 2 RAA, done between 2011 and 2019, two out of 31 cases presented anterior circulation abnormalities of nonatherosclerotic etiologies. [ 22 ] One with cerebrovascular insufficiency is caused by severe right CCA stenosis and steal phenomena. [ 19 ] The other case was pseudo-occlusion of the left ICA.…”

“…Dyspnea, coughing, and difficulty swallowing are the major symptoms that appear once Kommerell's diverticulum compresses the surrounding structures. [22] e likelihood of cerebral infarction will increase as a result, as cardiac abnormalities constitute at least 20% of the causes of ischemic strokes. [9,10] However, in this article, we report a case of RAA anomaly with an ALSA and Kommerell's diverticulum associated with aneurysmal dilation of the ascending aorta, left common carotid artery (CCA) stenosis of approximately 30-40%, and pancake kidney presented with a transient ischemic attack (TIA).…”

“…Dyspnea, coughing, and difficulty swallowing are the major symptoms that appear once Kommerell’s diverticulum compresses the surrounding structures. [ 22 ] The likelihood of cerebral infarction will increase as a result, as cardiac abnormalities constitute at least 20% of the causes of ischemic strokes. [ 9 , 10 ]…”