Hybrid repair of an adult with a double aortic arch, coarctation of the aorta, and left subclavian artery aneurysm

Abstract

We report the repair of a double aortic arch, coarctation of the aorta, and left subclavian artery (LSCA) aneurysm using a hybrid procedure in a 47-year-old woman. The patient underwent repair through a median sternotomy incision to bypass the left common carotid artery and LSCA. An endovascular approach was used to repair the coarctation of the aorta and to occlude the right aortic arch. Repair of this anomaly was advised because of worsening clinical symptoms and potential for fatal rupture or dissection of the LSCA aneurysm. Hybrid repair simplified what would have required a multistage open repair.

Aortic arch and frozen elephant trunk repair of a right-sided aortic arch with pseudoaneurysm rupture

“…Repair of such a defect was solely performed via thoracotomy until the early 1990s when endovascular repair techniques emerged. 2 Most of the data in long-term follow-up studies discuss persistent tracheal or esophageal compression and concomitant cardiovascular reoperations; however, we highlight a vascular complication after repair of a rare anatomic vascular ring. 3 …”

Airway management in vascular central airway obstruction: a literature review

“…Vascular rings [35] -Double aortic arch [44][45][46][47][48][49][50][51][52][53][54] -Right-sided double aortic arch and descending aorta [55] -Double aortic arch with Kommerell's diverticulum [63] -Left aortic arch with right ligamentum arteriosum and right descending aorta [33] with aberrant right subclavian artery [36] with aberrant right subclavian artery and Kommerell's diverticulum [38] -Right aortic arch [64] with aberrant left subclavian artery and left ligamentum arteriosum [36,39,43] with aberrant left subclavian artery and Kommerell's diverticulum [38,[40][41][42][43] -Pulmonary artery sling [56][57][58] Congenital aortic arch anomaly -Kommerell's diverticulum [21,22,[59][60][61] -Cervical aortic arch aneurysm [62] Congenital innominate artery anomaly -Anomalous innominate artery [65] Congenital heart diseases Pulmonary atresia and major aortopulmonary collateral arteries in Tetralogy of Fallot [32] Atrial septal defect [66] CAO, central airway obstruction.…”

“…43], double aortic arch [44][45][46][47][48][49][50][51][52][53][54], right-sided double aortic arch coexistence with a right-sided descending thoracic aorta [55], and pulmonary artery sling [56][57][58]; aneurysms arising from congenital aortic arch anomaly-Kommerell's diverticulum [21,22,[59][60][61] and cervical aortic arch [62]; Kommerell's diverticulum in combination with vascular rings [63]; rightsided aortic arch [64]; and anomalous innominate artery [65] can cause vascular CAO in adults. Also, congenital heart diseases that cause aneurysmal artery dilation, for example, atrial septal defect accompanied with dilated right pulmonary artery [66], and pulmonary atresia with aneurysmally dilated aortopulmonary collateral arteries in Tetralogy of Fallot [32] may obstruct the tracheobronchial tree in adults when the extraluminal pressure arising by the dilated arteries exceeds the durability of the airway.…”