Robotically assisted mitral valve repair has proven its efficacy during the last decade. The most suitable approach for patients with difficult anatomies, such as morbid obesity, sternal deformities, cardiac rotation, or vascular anomalies, represents a current challenge in cardiac surgery. Herein, we present the case of a 71-year-old patient affected by severe degenerative mitral valve regurgitation with pectus excavatum and a right aortic arch with an anomalous course of the left subclavian artery who was successfully treated using a Da Vinci–assisted approach.
Aged ; Aorta, Thoracic ; Congenital Abnormalities ; Funnel Chest ; Humans ; Mitral Valve Insufficiency ; Mitral Valve ; Obesity, Morbid ; Subclavian Artery ; Thoracic Surgery

OBJECTIVE: Duplication of the vertebral artery (VA) is a rare vascular variant. This paper describes the anatomy and embryological development of duplicated VAs and reviews the clinical significance.METHODS: Computed tomography (CT) angiography was performed in 3386 patients (1880 females, 1506 males) between March 2014 and November 2015. We defined duplication of the VA as a condition in which the VA has two origins that fused at different levels of the neck.RESULTS: Ten of the 3386 patients (0.295%) who received CT angiography had a dual origin of the VA; three on the left side, and seven on the right side. In all seven with right dual origin of the VA, both limbs of the VA origin originated from the right subclavian artery. In all three patients with left dual origin of the VA, both limbs of the VA originated from the left subclavian artery and aortic arch. In all 10 patients, the medial limb of the duplicated VA was located posteriorly and medially to the common carotid artery (CCA) and anteriorly and laterally to the vertebral transverse foramen. In two patients, the medial limb of the duplicated VA was located in close proximity to the CCA. In another two patients, the medial limb of the duplicated VA was located in close proximity to the CCA, carotid bifurcation, and proximal internal carotid artery.CONCLUSION: Although duplication of the VA is asymptomatic in most patients, clinicians should consider this anomaly during diagnosis and treatment.
Angiography ; Aorta, Thoracic ; Carotid Artery, Common ; Carotid Artery, Internal ; Congenital Abnormalities ; Diagnosis ; Embryonic Development ; Extremities ; Female ; Humans ; Neck ; Pregnancy ; Subclavian Artery ; Vertebral Artery

Aneurysm ; pathology ; Aneurysm, Dissecting ; diagnosis ; Cardiovascular Abnormalities ; pathology ; Deglutition Disorders ; pathology ; Humans ; Male ; Middle Aged ; Subclavian Artery ; abnormalities ; pathology

Aorta, Thoracic ; abnormalities ; Child, Preschool ; Ductus Arteriosus, Patent ; complications ; Female ; Humans ; Pulmonary Artery ; abnormalities ; Subclavian Artery ; abnormalities

An aberrant right subclavian artery (ARSA) is the most common vascular abnormality of the aortic arch and is associated with development of aneurysms in 3-8% of these anomalies. In this case report, we describe an 84-year-old man with a symptomatic ARSA treated with staged hybrid procedure combining surgical replacement of the ascending aorta and bilateral carotid-to-subclavian artery bypass with implantation of a stent graft in the aortic arch and descending aorta. Our case suggests that a less invasive hybrid therapy can be performed successfully for the treatment of ARSA with aneurysmal change in patients at high surgical risk.
Aneurysm ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic ; Arteries ; Cardiovascular Abnormalities ; Endovascular Procedures ; Humans ; Stents ; Subclavian Artery ; Transplants

Double aortic arch with an atretic left arch distal to the origin of left subclavian artery was diagnosed with multi-detector row computed tomography (MDCT) in two children with dysphagia. This rare type of complete vascular ring is clinically important because it may be confused with right aortic arch in mirror imaging. Anatomic details of this rare type of complete vascular ring demonstrated on MDCT facilitated appropriate surgical treatment.
Adolescent ; Aorta, Thoracic/*abnormalities/radiography/surgery ; Child, Preschool ; Deglutition Disorders/etiology/radiography/surgery ; Female ; Humans ; Multidetector Computed Tomography/*methods ; Subclavian Artery/*abnormalities/radiography/surgery ; Vascular Malformations/complications/*radiography/surgery ; Vascular Surgical Procedures

Although Bochdalek hernia is the most common congenital diaphragmatic hernia in adults, bilateral occurrence is rare. To the best of our knowledge, only case reports on Bochdalek hernia and its associated pathologies have been previously published. Herein, we present the case of a 27-year-old man with bilateral Bochdalek hernias, which were detected incidentally. The bilateral Bochdalek hernias were found to be associated with severe aortic tortuosity and aberrant right subclavian artery.
Adult ; Angiography ; Aortic Diseases ; diagnostic imaging ; Hernia, Diaphragmatic ; diagnostic imaging ; Humans ; Incidental Findings ; Male ; Subclavian Artery ; abnormalities ; Tomography, X-Ray Computed

Kommerell's diverticulum is a rare congenital disorder characterized by typical right sided aortic arch and aberrant left subclavian artery which are usually detected by accident in asymptomatic patients. However, some of patients complain of severe symptoms caused by compression of the adjacent organs or complicated aortic dissection by the diverticulum. Early detection of the disease can lead to elective surgical correction. In this article, we report a Kommerell's diverticulum case initially detected by transesophageal echocardiography.
Aneurysm ; Aorta, Thoracic ; Cardiovascular Abnormalities ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Deglutition Disorders ; Diverticulum ; Echocardiography, Transesophageal ; Humans ; Subclavian Artery

The left aortic arch with an aberrant right subclavian artery, or arteria lusoria, is the most common aortic arch anomaly, occurring in 0.5-2.5% of individuals. In such cases, the angular course of the arteria lusoria to the ascending aorta imposes difficulty in passing a guide wire to the ascending aorta during right transradial catheterization. Here, the case of a 53-year-old woman with intermittent chest tightness and coughing is reported. Aberrant right subclavian artery (arteria lusoria) was diagnosed via aortogram during right transradial coronary angiography. Compression of the esophagus and trachea by the aberrant right subclavian artery was demonstrated by chest computed tomography (CT).
Aneurysm ; Aorta ; Aorta, Thoracic ; Cardiovascular Abnormalities ; Catheterization ; Catheters ; Coronary Angiography ; Cough ; Deglutition Disorders ; Esophagus ; Female ; Humans ; Middle Aged ; Subclavian Artery ; Thorax ; Trachea

PHACE association is a rare neurocutaneous condition in which facial hemangiomas associate with a spectrum of posterior fossa malformations, arterial cerebrovascular anomalies, cardiovascular anomalies, and eye anomalies. We reported a case of PHACE association in a premature infant showing facial, intracranial, and oropharyngeal hemangiomas with evidence of the Dandy-Walker variant and complicated cardiovascular anomalies, including a right-sided aortic arch and an atypical patent ductus arteriosus arising from a tortuous left subclavian artery. To our knowledge, intracranial hemangiomas are rare in PHACE association, and a concomitant oropharyngeal hemangioma has not been previously reported in the PHACE association literature. In infants presenting with large, plaque-like facial hemangiomas, it is important to conduct active cardiovascular and neurological evaluations. Special attention should be given to the laryngoscopic examination to search for additional hemangiomas in the airway.
Aorta, Thoracic ; Aortic Coarctation ; Ductus Arteriosus, Patent ; Eye ; Eye Abnormalities ; Hemangioma ; Hemangioma, Cavernous, Central Nervous System ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Neurocutaneous Syndromes ; Subclavian Artery