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Baudo M, Varrica A, Reali M, Saracino A, Carminati M, Frigiola A, Giamberti A, Lo Rito M. Cervical aortic arch in the pediatric population: a meta-analysis of individual patient's data. Front Cardiovasc Med 2023; 10:1266956. [PMID: 37855019 PMCID: PMC10580808 DOI: 10.3389/fcvm.2023.1266956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023] Open
Abstract
Background This is the first meta-analysis to analyze all reports of published pediatric cases of cervical aortic arch (CAA) by highlighting the clinical characteristics and treatment outcomes using the reported individual data of the patients. The aim of the study is to investigate the clinical features and surgical outcomes of such a rare disease in the pediatric population. Methods A comprehensive search was conducted in various academic databases, including PubMed, ScienceDirect, SciELO, DOAJ, and Cochrane Library, until June 2022 for case reports describing the presence of cervical aortic arch in the pediatric age. Case reports and series were included if the following criteria were met: (1) description of the cervical aortic arch; (2) patient of pediatric age; and (3) published in the English language. All other types of publications that lacked patient-specific information were excluded from the analysis. This systematic review was conducted in accordance with the PRISMA guidelines. The primary outcome measure of the analysis was early and late mortality. Results The literature search identified 2,272 potentially eligible articles, 72 of which met our inclusion criteria with 96 patients including the author's institutional case. At a median of 365 (90-730) days, the overall cohort registered a 7.3% (7/96) mortality rate. In the subset of patients who underwent surgery, the mortality rate was also 7.3% (4/55), and the mortality rate following surgery to treat only CAA was 2.4% (1/42). Dyspnea was identified as an independent determinant of mortality by employing the univariable Firth bias-reduced logistic regression method. Conclusion Cervical aortic arch is a rare congenital heart disease that poses treatment challenges due to the high anatomical variability, diverse clinical presentations, and the presence of other concomitant diseases. The surgical treatment appears to be a safe and effective approach for resolving the symptoms, although it needs to be tailored individually for each patient. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346826, Identifier: CRD42022346826.
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Affiliation(s)
- Massimo Baudo
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alessandro Varrica
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Matteo Reali
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonio Saracino
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mario Carminati
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Wu YK, Mao Q, Zhou MT, Liu N, Yu X, Peng JC, Tao YY, Gong XQ, Yang L, Zhang XM. Cervical aortic arch with aneurysm formation and an anomalous right subclavian artery and left vertebral artery: A case report. World J Clin Cases 2022; 10:3291-3296. [PMID: 35603333 PMCID: PMC9082699 DOI: 10.12998/wjcc.v10.i10.3291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/08/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A cervical aortic arch (CAA) refers to a high-riding aortic arch (AA) that often extends above the level of the clavicle. This condition is very rare, with an incidence of less than 1/10000. CASE SUMMARY A 29-year-old woman was admitted to the otolaryngology department of our hospital for repeated bilateral purulent nasal discharge for the prior 3 mo. The patient was diagnosed with chronic sinusitis and chronic rhinitis at admission. A preoperative noncontrast chest computed tomography scan showed a high-riding, tortuous AA extending to the mid-upper level of the first thoracic vertebra with local cystic dilatation. A further computed tomography angiography examination showed that the brachiocephalic trunk, left common carotid artery, left vertebral artery (LVA) (slender), and left subclavian artery sequentially branched off of the aorta from the proximal end to the distal end of the AA. The proximal end of the right subclavian artery (RSCA) was tortuous and dilated. The AA showed tumor-like local expansion, with a maximum diameter of approximately 4 cm. After consultation with the department of cardiac macrovascular surgery, the patient was diagnosed with left CAA with aneurysm formation and an anomalous RSCA and LVA and was transferred to that department. The patient underwent AA aneurysm resection and artificial blood vessel replacement under general anesthesia and cardiopulmonary bypass. No abnormality was found during the 2-mo follow-up after discharge. CONCLUSION A CAA is a rare congenital anomaly of vascular development. The present unique case of CAA with aneurysm formation and an anomalous RSCA and LVA enriches existing CAA data.
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Affiliation(s)
- Yao-Kun Wu
- Medical Imaging Key Laboratory of Sichuan Province, Nanchong 637000, Sichuan Province, China
- Medical Research Center, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Qi Mao
- Medical Imaging Key Laboratory of Sichuan Province, Nanchong 637000, Sichuan Province, China
- Medical Research Center, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Mao-Ting Zhou
- Medical Imaging Key Laboratory of Sichuan Province, Nanchong 637000, Sichuan Province, China
- Medical Research Center, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Ning Liu
- Medical Imaging Key Laboratory of Sichuan Province, Nanchong 637000, Sichuan Province, China
- Medical Research Center, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xi Yu
- Medical Imaging Key Laboratory of Sichuan Province, Nanchong 637000, Sichuan Province, China
- Medical Research Center, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Jin-Cheng Peng
- Medical Imaging Key Laboratory of Sichuan Province, Nanchong 637000, Sichuan Province, China
- Medical Research Center, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Yun-Yun Tao
- Medical Imaging Key Laboratory of Sichuan Province, Nanchong 637000, Sichuan Province, China
- Medical Research Center, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xue-Qin Gong
- Medical Imaging Key Laboratory of Sichuan Province, Nanchong 637000, Sichuan Province, China
- Medical Research Center, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Lin Yang
- Medical Research Center, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xiao-Ming Zhang
- Medical Imaging Key Laboratory of Sichuan Province, Nanchong 637000, Sichuan Province, China
- Medical Research Center, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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Wu YK, Mao Q, Zhou MT, Liu N, Yu X, Peng JC, Tao YY, Gong XQ, Yang L, Zhang XM. Cervical aortic arch with aneurysm formation and an anomalous right subclavian artery and left vertebral artery: A case report. World J Clin Cases 2022. [DOI: https://dx.doi.org/10.12998/wjcc.v10.i10.3291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Shayan G, Shao J, Wang Y, Si L, Shen J, Chen Y, Liu B, Zheng Y. Management of cervical aortic arch complicated by multiple aneurysms. Interact Cardiovasc Thorac Surg 2019; 29:295–301. [PMID: 30903156 DOI: 10.1093/icvts/ivz087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Cervical aortic arch with aneurysm formation is considered an extremely rare condition. Here, we summarize our experience in treating 8 patients. We validated extra-anatomic ascending-to-infrarenal abdominal aorta bypass through the retroperitoneal cavity without circulatory arrest as an alternative treatment for patients with a tortuous arch that was unsuitable for endovascular repair. METHODS From March 2015 to April 2018, 8 patients (7 women; median age 46 years) diagnosed with cervical aortic arch complicated with aneurysm formation were treated at Peking Union Medical College Hospital and the Affiliated Hospital of Qingdao University. After assessment of the anatomical characteristics, 4 patients underwent endovascular repair. Three patients with a tortuous aortic arch and saccular aneurysm formation between the left common carotid artery and the left subclavian artery were treated with an extra-anatomic ascending-to-infrarenal abdominal aorta bypass and aneurysm indwelling. One patient refused surgical intervention and is being followed up on a yearly basis at our outpatient clinic. No circulatory arrest was required during surgery. RESULTS No severe postoperative complications were observed during follow-up (6-36 months). Postoperative computed tomography angiography revealed patent blood flow in the prosthetic aortic graft bypass. No endoleak, migration or stenosis of the stent grafts was observed in patients following endovascular repair. The left subclavian artery was preserved in 3 patients. Follow-up computed tomography angiography revealed satisfactory postoperative results in all patients, with no signs of aortic dilation or coarctation. CONCLUSIONS Ascending-to-infrarenal abdominal aorta bypass through the retroperitoneal cavity is a safe and effective treatment for cervical aortic arch with a tortuous aorta complicated by aneurysm formation and coarctation.
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Affiliation(s)
- Gulidanna Shayan
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China.,School of Medicine, Tsinghua University, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
| | - Yuewei Wang
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Loubin Si
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
| | - Junyue Shen
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China.,School of Medicine, Tsinghua University, Beijing, China
| | - Yu Chen
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
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Zhong YL, Ma WG, Zhu JM, Qiao ZY, Zheng J, Liu YM, Sun LZ. Surgical repair of cervical aortic arch: An alternative classification scheme based on experience in 35 patients. J Thorac Cardiovasc Surg 2019; 159:2202-2213.e4. [PMID: 31376997 DOI: 10.1016/j.jtcvs.2019.03.143] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cervical aortic arch (CAA) is rare and difficult to repair. Clinical experience is limited. We report the surgical techniques and midterm outcomes in 35 patients with CAA based on an alternative classification scheme. METHODS Of 35 patients with CAA, 30 (85.7%) had left-sided aortic arch and 5 had (14.3%) right-sided aortic arch (all 5 had a vascular ring). Mean age was 34.2 ± 13.1 years, 23 were female (65.7%), and 18 were asymptomatic (51.4%). Surgical access and procedure were chosen according to an alternative classification scheme that is based on the presence or absence of vascular ring and relationship of descending aorta to the side of the aortic arch. In the left-sided aortic arch group, aortic arch reconstruction though median sternotomy was performed in 15 patients, and distal arch and descending thoracic aortic replacement via left thoracotomy in 15 patients. In the right-sided aortic arch group, ascending-to-descending aortic bypass was done via median sternotomy in 2 patients and right thoracotomy in 1, and distal arch and descending thoracic aortic replacement via right thoracotomy in 2 patients. RESULTS Neither death nor spinal cord injury occurred. Left recurrent laryngeal nerve injury, prolonged ventilation, and reexploration for bleeding occurred in 1 each. In 11 patients with coarctation, the upper-lower limb gradient decreased significantly postoperatively (from 34.0 ± 12.7 to 10.2 ± 2.7 mm Hg; P < .01). The diseased aortic segment was excluded in 34 patients, except 1 with residual aneurysm in the proximal descending thoracic aorta. Follow-up was complete in 100% at mean 4.4 ± 2.0 years. No late death, limb ischemia, or stroke occurred. Endovascular repair was performed in 1 patient, and ascending aortic dilation occurred in 1 patient. The residual aorta remained nondilated in 33 patients. Aortic grafts were patent in 100%, with no anastomotic leak or pseudoaneurysm. At 6 years, the incidences of death, aortic events, and event-free survival were 0%, 6.5%, and 93.5%, respectively. CONCLUSIONS Open repair of CAA can achieve favorable early and midterm outcomes. Surgical accesses and procedures should be chosen based on type of CAA, anatomic variations and associated anomalies. Our alternative categorization scheme of CAA is intuitive and comprehensive, which may facilitate classification and surgical decision making.
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Affiliation(s)
- Yong-Liang Zhong
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Wei-Guo Ma
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Jun-Ming Zhu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China.
| | - Zhi-Yu Qiao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Jun Zheng
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Yong-Min Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
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Türkoğlu S, BEDEL C. Cervical aortic arch. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2019. [DOI: 10.32322/jhsm.479578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Zientara A, Schwegler I, Attigah N, Genoni M, Dzemali O. Anomaly of Haughton type D left cervical aortic arch in combination with type B dissection: case report and literature review. J Cardiothorac Surg 2018; 13:79. [PMID: 29945646 PMCID: PMC6020350 DOI: 10.1186/s13019-018-0768-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/20/2018] [Indexed: 01/11/2023] Open
Abstract
Background The 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 presentation A 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. Conclusion The 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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Affiliation(s)
- Alicja Zientara
- Department of Cardiac Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland.
| | - Igor Schwegler
- Department of Vascular Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
| | - Nicolas Attigah
- Department of Vascular Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
| | - Michele Genoni
- Department of Cardiac Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
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Binsalamah ZM, Zea-Vera R, Fraser CD. Cervical left aortic arch with distal tortuosity causing coarctation and aneurysmal formation in a child. J Card Surg 2018; 33:466-468. [DOI: 10.1111/jocs.13750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Ziyad M. Binsalamah
- Congenital Heart Surgery; Texas Children's Hospital − Baylor College of Medicine; Houston Texas
| | - Rodrigo Zea-Vera
- Congenital Heart Surgery; Texas Children's Hospital − Baylor College of Medicine; Houston Texas
| | - Charles D. Fraser
- Congenital Heart Surgery; Texas Children's Hospital − Baylor College of Medicine; Houston Texas
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Barbee JP, Stevens SL, Gaines TE, Gash JR. Endovascular Repair of Cervical Aortic Arch Aneurysm. Vasc Endovascular Surg 2016; 41:355-7. [PMID: 17704342 DOI: 10.1177/1538574407302847] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cervical aortic arch (CAA) is a rare congenital anomaly of the aortic arch. Rarely, CAA is associated with aneurysm of the arch and great vessels. A 32-year-old male patient, previously in good health, presented with 2 weeks of severe chest pain. Radiographic evaluation revealed a CAA with aneurysmal dilation of the distal aortic arch. The aneurysm extended into the left subclavian artery. There was also marked angulation just distal to the aneurysmal portion. The aneurysmal arch and subclavian artery were repaired using a thoracic aortic endograft. An open axillary-to-axillary bypass was performed, and the left axillary artery was ligated proximally. This restored perfusion to the left upper extremity and effectively excluded the aneurysm sac. Immediately postoperatively, the patient's chest pain resolved, and he has remained symptom free. To the authors' knowledge, this is the first reported repair of a cervical arch aneurysm by endovascular technique.
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Affiliation(s)
- Jacob P Barbee
- University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA.
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Kaul P. 11 cm Haughton D left cervical aortic arch aneurysm. J Cardiothorac Surg 2013; 8:108. [PMID: 23618036 PMCID: PMC3639062 DOI: 10.1186/1749-8090-8-108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 04/15/2013] [Indexed: 12/15/2022] Open
Abstract
A 56 year old Caucasian man presented with sudden loss of consciousness while driving and was found to have an 11 cm Haughton D type left cervical aortic arch aneurysm with normal brachiocephalic branching and normal descending thoracic laterality but with considerable tortuosity and redundancy of aortic arch. The aneurysm arose between the left common carotid artery and the left subclavian artery. It compressed and stretched the left common carotid artery, compressed the pulmonary trunk and the left pulmonary artery, stretched the vagus, left recurrent laryngeal and left phrenic nerves and caused extreme deviation of trachea, severely compromising the tracheal lumen. Patient underwent successful interposition graft replacement of distal aortic arch under total circulatory arrest and selective unihemispherical cerebral perfusion.
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Affiliation(s)
- Pankaj Kaul
- Leeds General Infirmary, Yorkshire Heart Centre, Great George Street, Leeds LS1 3EX, UK.
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Charrot F, Tarmiz A, Glock Y, Léobon B. Diagnosis and surgical treatment of an aneurysm on a cervical aortic arch associated with an anomalous origin of the left main coronary artery. Interact Cardiovasc Thorac Surg 2010; 10:346-7. [DOI: 10.1510/icvts.2009.219352] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Left-sided Cervical Aortic Arch Associated With Pseudocoarctation, Aneurysm Formation, and Anomalous Left Brachiocephalic Vein. J Thorac Imaging 2008; 23:206-9. [DOI: 10.1097/rti.0b013e318178829c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Mitsumori Y, Tsuchiya K, Nakajima M, Fukuda S, Morimoto H. Surgical repair of left-sided cervical aortic arch aneurysm: case report and literature review. Ann Vasc Surg 2008; 22:140-4. [PMID: 18191070 DOI: 10.1016/j.avsg.2007.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Revised: 06/19/2007] [Accepted: 07/23/2007] [Indexed: 10/21/2022]
Abstract
Cervical aortic arch (CAA) is a rare vascular malformation which sometimes accompanies other cardiovascular malformations. Surgical approaches such as a lateral thoracotomy and a median sternotomy are selected depending on the position and type of aneurysm and other associated malformations. We herein report the case of a CAA patient who was a 38-year-old female and demonstrated an aneurysm between the left common carotid artery and left subclavian artery in addition to the persistence of the left superior vena cava (PLSVC). During surgery, the aortic arch from the distal right brachiocephalic trunk bifurcation to the proximal left subclavian artery bifurcation was replaced with a prosthetic graft to reconstruct the left common carotid artery. The median sternotomy approach was selected. Hypothermic circulatory arrest was performed using a cardiopulmonary bypass (CPB), and anterograde cerebral perfusion was conducted from the brachiocephalic trunk. The patient was discharged from the hospital without any complications 16 days after surgery. Magnetic resonance angiography was useful for diagnosing the precise position of the aneurysm. When encountering an aneurysm associated with the CAA in the transverse aortic arch or PLSVC, the median sternotomy approach is considered the treatment of choice.
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Affiliation(s)
- Yoshitaka Mitsumori
- Department of Cardiovascular Surgery, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
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Affiliation(s)
- Roberto Lorusso
- Cardiac Surgery Division, Civic Hospital, Piazzale Spedali Civili 1, Brescia, Italy.
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