Published online Feb 26, 2017. doi: 10.4330/wjc.v9.i2.191
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
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.