Mayer J, van der Werf-Grohmann N, Kroll J, Spiekerkoetter U, Stiller B, Grohmann J. Dysphagia after arteria lusoria dextra surgery: Anatomical considerations before redo-surgery. World J Cardiol 2017; 9(2): 191-195 [PMID: 28289534 DOI: 10.4330/wjc.v9.i2.191]
Corresponding Author of This Article
Jochen Grohmann, MD, Department of Congenital Heart Disease and Pediatric Cardiology, Heart Center, Freiburg University, Mathildenstrasse 1, 79106 Freiburg, Germany. jochen.grohmann@universitaets-herzzentrum.de
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Feb 26, 2017; 9(2): 191-195 Published online Feb 26, 2017. doi: 10.4330/wjc.v9.i2.191
Dysphagia after arteria lusoria dextra surgery: Anatomical considerations before redo-surgery
Judith Mayer, Natascha van der Werf-Grohmann, Johannes Kroll, Ute Spiekerkoetter, Brigitte Stiller, Jochen Grohmann
Judith Mayer, Natascha van der Werf-Grohmann, Ute Spiekerkoetter, Department of Pediatrics and Adolescent Medicine, Freiburg University, 79106 Freiburg, Germany
Johannes Kroll, Department of Cardiovascular Surgery, Heart Center, Freiburg University, 79106 Freiburg, Germany
Brigitte Stiller, Jochen Grohmann, Department of Congenital Heart Disease and Pediatric Cardiology, Heart Center, Freiburg University, 79106 Freiburg, Germany
Author contributions: Mayer J drafted the initial and further case report; Kroll J as experienced pediatric cardiovascular surgeon performed both operations and contributed important, detailed information for the surgical and anatomical discussion; Grohmann J was one of the leading cardiologists in charge during the entire duration of treatment and played an important role in developing and reviewing the final manuscript; all authors were involved in the patient management as an interdisciplinary team, critically reviewed the manuscript and approved the final manuscript as submitted.
Institutional review board statement: None.
Informed consent statement: All involved persons, or their legal guardians, provided informed written consent prior to submitting the case report.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jochen Grohmann, MD, Department of Congenital Heart Disease and Pediatric Cardiology, Heart Center, Freiburg University, Mathildenstrasse 1, 79106 Freiburg, Germany. jochen.grohmann@universitaets-herzzentrum.de
Telephone: +49-761-27043000 Fax: +49-761-27044680
Received: October 13, 2016 Peer-review started: October 17, 2016 First decision: November 14, 2016 Revised: November 28, 2016 Accepted: December 13, 2016 Article in press: December 15, 2016 Published online: February 26, 2017 Processing time: 133 Days and 9.7 Hours
Abstract
Aberrant right subclavian artery (arteria lusoria) is the most common congenital root anomaly, remaining asymptomatic in most cases. Nevertheless, some of the 20%-40% of those affected present tracheo-esophageal symptoms. We report on a 6-year-old previously healthy girl presenting with progressive dysphagia over 4 wk. Diagnostics including barium swallow, echocardiography and magnetic resonance angiography (MRA) revealed a retro-esophageal compression by an aberrant right subclavian artery. Despite the successful, uneventful transposition of this arteria lusoria to the right common carotid via right-sided thoracotomy, the girl was suffering from persisting dysphagia. Another barium swallow showed the persistent compression of the esophagus on the level where the arteria lusoria had originated. As MRA showed no evidence of a significant re-obstruction by the transected vascular stump, we suspected a persisting ligamentum arteriosum. After a second surgical intervention via left-sided thoracotomy consisting of transecting the obviously persisting ligamentum and shortening the remaining arterial stump of the aberrant right subclavian artery, the patient recovered fully. In this case report we discuss the potential relevance of a persisting ligamentum arteriosum for patients with left aortic arch suffering from dysphagia lusoria and rational means of diagnosing, as well as the surgical options to prevent re-do surgery.
Core tip: We present a pediatric case of dysphagia caused by the common congenital root anomaly of an aberrant right subclavian artery. However, persisting symptoms after primary treatment via right-sided thoracotomy required redo-surgery via left-sided thoracotomy with transection of a persisting ligamentum arteriosum and shortening of the remaining lusorian arteries’ stump. Based on this experience, we want to emphasize the potential co-existence of a compressing ligamentum arteriosum even in patients with left aortic arch.
