Right-sided Aortic Arch with Aberrant Left Subclavian Artery in a Pregnant Female: A Case Report and Literature Review

Angelina Zhyvotovska¹, Denis Yusupov¹, Rishard Abdul¹, Harshith Chandrakumar¹, Angeleque Hartt¹, Khaleda Akter¹, Yusra Qaiser¹ and Samy I Mc Farlane^1,

¹Department of Medicine, SUNY- Downstate, Health Science University. 450 Clarkson Avenue, Brooklyn, NY 11203

Cite this paper

Angelina Zhyvotovska, Denis Yusupov, Rishard Abdul, Harshith Chandrakumar, Angeleque Hartt, Khaleda Akter, Yusra Qaiser and Samy I Mc Farlane. Right-sided Aortic Arch with Aberrant Left Subclavian Artery in a Pregnant Female: A Case Report and Literature Review. American Journal of Medical Case Reports. 2020; 8(6):143-147. doi: 10.12691/AJMCR-8-6-2

Abstract

Right-sided aortic arch with aberrant left subclavian artery is a rare variant of vascular anatomy. Three types of right-sided aortic arches are described and classified based on the arrangement of the aortic arch vessels, the presence or absence of congenital heart abnormalities, the relationship of the aortic arch to the trachea and esophagus, as well as the presence or absence of a complete or incomplete vascular ring. On review of the existing literature, 31 case reports were found with a spectrum of clinical presentation sand outcomes. In this case report, we highlight a case of a young female in her early 20’swho presented with choking spells, shortness of breath along with intermittent dysphagia since childhood. She was otherwise healthy and pregnant at 26 weeks gestational age. A Computed tomography scan with angiography (CTA) of the thorax was performed to rule out a pulmonary embolism (PE) however surprisingly, a right-sided aortic arch with aberrant left subclavian artery was revealed instead. Subsequently, an extensive literature review was carried out to better understand clinical presentation sand treatment strategies for this rather rare disorder.

Keywords

right-sided aortic arch with aberrant left subclavian artery, right aortic arch, congenital abnormalities, aberrant left subclavian artery, vascular ring

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Cina CS, Althani H, Pasenau J, Abouzahr L. Kommerell's diverticulum and right-sided aortic arch: a cohort study and review of the literature. J Vasc Surg. 2004; 39(1): 131-139.
[2]	Hara M, Kitase M, Satake M, et al. A case of right-sided aortic arch with isolation of the left subclavian artery: CT findings. Radiat Med. 2001; 19(1): 33-36.
[3]	Mubarak MY, Kamarul AT, Noordini MD. Right-sided Aortic Arch with Aberrant Left Subclavian Artery from Kommerell's Diverticulum. Iran J Radiol. 2011; 8(2): 103-106.
[4]	Yang MH, Weng ZC, Weng YG, Chang HH. A right-sided aortic arch with Kommerell's diverticulum of the aberrant left subclavian artery presenting with syncope. J Chin Med Assoc. 2009; 72(5): 275-277.
[5]	Arakoni R, Merrill R, Simon EL. Foreign body sensation: A rare case of dysphagia lusoria in a healthy female. Am J Emerg Med. 2018; 36(11): 2134 e2131-2134 e2132.
[6]	Morosetti D, Di Stefano C, Mondillo M, et al. Right-sided aortic arch with mirror image branching and situs solitus: a case of a 79 years old woman. Radiol Case Rep. 2019; 14(10): 1246-1251.
[7]	Masuoka H, Miyauchi A, Higashiyama T, Yabuta T, Kihara M, Miya A. Right-sided aortic arch and aberrant left subclavian artery with or without a left nonrecurrent inferior laryngeal nerve. Head Neck. 2016; 38(10): E2508-2511.
[8]	Raymond SL, Gray SE, Peters KR, Fatima J. Right-sided aortic arch with aberrant left subclavian artery and Kommerell diverticulum. J Vasc Surg Cases Innov Tech. 2019; 5(3): 259-260.
[9]	Morishita A, Tomioka H, Katahira S, Hoshino T, Hanzawa K. Surgical Treatment for Kommerell's Diverticulum Associated with a Right-Sided Aortic Arch and an Aberrant Left Subclavian Artery: Endovascular or Hybrid. Ann Vasc Dis. 2019; 12(2): 228-232.
[10]	Zhao C, Sun Y, Wang Y, et al. Bicuspid aortic valve with right-sided aortic arch aneurysm and Kommerell's diverticulum. J Clin Ultrasound. 2019.
[11]	Tanaka Y, Kitamura T, Irisawa Y, Miyaji K. Total arch replacement using the Gelweave Lupiae graft for an aneurysm arising from Kommerell's diverticulum with an aberrant left subclavian artery and right-sided aortic arch. Interact Cardiovasc Thorac Surg. 2018; 27(2): 307-309.
[12]	Tempaku A, Kuroiwa T, Nishio A. Aberrant left subclavian artery occlusion in right-sided aortic artery associated with left cerebral infarction: A case report. Interv Neuroradiol. 2018; 24(3): 322-326.
[13]	Hamady M, Sharma PM, Patel R, Godfrey AD, Bicknell CD. Hybrid endovascular repair of aneurysmal right-sided aortic arch and Kommerell's diverticulum using a two-vessel branched stent graft: Case report and review of literature. SAGE Open Med Case Rep. 2017; 5: 2050313X17749082.
[14]	Wilinski J, Skwarek A, Kasprzyk A, Wilinski B, Kameczura T, Glowacki MD. Right-sided aortic arch with aberrant left subclavian artery and hearing loss in patient with abnormal cardiomediastinal contours in routine chest X-ray. Przegl Lek. 2017; 74(3): 125-128.
[15]	Bhatt TC, Muralidharan CG, Singh G, Jain NK. Kommerell's diverticulum: A rare aortic arch anomaly. Med J Armed Forces India. 2016; 72(Suppl 1): S80-S83.
[16]	Powell BL. Vascular ring presenting as dysphagia in an adult woman: a case report. Ann R Coll Surg Engl. 2017; 99(1): e3-e5.
[17]	Ahmed MM, Yoon DY, Desai SS, Pearce WH. Right-sided aortic arch with isolated left subclavian artery leading to subclavian steal syndrome. J Vasc Surg. 2016; 64(1): 233-234.
[18]	Lococo F, Tusini N, Brandi L, et al. Successful Conservative Treatment of a Kommerell Aneurysm Associated With Right-Sided Aortic Arch. Vasc Endovascular Surg. 2016; 50(6): 458-459.
[19]	Parikh P, Nasa M, Patil S, Patel J, Bhate P, Sawant P. A Rare Cause of Dysphagia--Kommerell's Diverticulum. J Assoc Physicians India. 2015; 63(1): 59-62.
[20]	Ohtani T, Yamazaki T, Ohtaki H, et al. Carotid Artery Stenting in Right-sided Aortic Arch: A Case Report. NMC Case Rep J. 2016; 3(1): 9-12.
[21]	Stefanczyk L, Szymczyk K, Stefanczyk K, Polguj M. The Presence of a Right Aortic Arch Associated with Severe Stenosis of the Right Common Carotid Artery and Steal Phenomenon. Ann Vasc Surg. 2015; 29(8): 1656 e1613-1657.
[22]	Sierra-Galan LM, Shveid-Gerson D, Gomez-Garza G, Rey-Rodriguez A. Double incomplete aortic arch and Kommerell's Diverticulum as a cause of chronic cough. Arch Cardiol Mex. 2015; 85(2): 158-160.
[23]	Inui T, Hashimoto H, Fujimoto K, et al. [Percutaneous transluminal angioplasty using a stent for an aberrant left subclavian artery stenosis with a right-sided aortic arch: a case report]. No Shinkei Geka. 2014; 42(10): 937-942.
[24]	Lee CH, Son JW, Park JS. Comprehensive three-dimensional analysis of right-sided aortic arch with multiple vascular anomalies. BMC Cardiovasc Disord. 2014; 14:104.
[25]	Zhang M, Yuan Y, Hu Y, et al. Endovascular repair with the chimney technique for stanford type B aortic dissection involving right-sided arch with aberrant left subclavian artery. Ann Vasc Surg. 2014;28(7): 1798 e1797-1798 e1710.
[26]	Batheeb NA, Habbab LM, Qattan NM. Symptomatic stenosis of left subclavian artery from Kommerell's diverticulum. Asian Cardiovasc Thorac Ann. 2015; 23(9): 1068-1071.
[27]	Khalid S, Narayansamy S, Siddiqui S, Mohd K. Middle-aged woman with dysphagia to solid. Diagnosis: Right-sided aortic arch with an aberrant left subclavian artery. Saudi J Gastroenterol. 2014; 20(1): 76-77.
[28]	Samas J, Manetta F, Meyer DB. Repair of vascular ring with resection of kommerell diverticulum and transposition of aberrant left subclavian artery. Int J Angiol. 2013; 22(4): 243-244.
[29]	Ebner L, Huber A, Christe A. Right aortic arch and Kommerell's diverticulum associated with acute aortic dissection and pericardial tamponade. Acta Radiol Short Rep. 2013; 2(1): 2047981613476283.
[30]	Motoki M, Hattori K, Kato Y, et al. Endovascular repair of ruptured aberrant left subclavian artery with right aortic arch. Ann Thorac Surg. 2013; 95(2): 699-701.
[31]	Yamashiro S, Nagano T, Kuniyoshi Y, Kise Y, Maeda T, Arakaki R. Endovascular repair of intrathoracic ruptured Kommerell's diverticulum. Asian Cardiovasc Thorac Ann. 2012; 20(5): 587-590.
[32]	Suarez AE, Slivka R. Acute superior vena cava syndrome after rupture of Kommerell's diverticulum: a case report. Ann Emerg Med. 2013; 61(3): 348-350.
[33]	Margolis J, Bilfinger T, Labropoulos N. A right-sided aortic arch and aberrant left subclavian artery with proximal segment hypoplasia. Interact Cardiovasc Thorac Surg. 2012; 14(3): 370-371.
[34]	Panduranga P, Al-Delamie T, Ratnam L, Al-Mukhaini M, Zachariah S. Repair of Kommerell's diverticulum with aberrant left subclavian artery in an elderly patient with right aortic arch and dysphagia lusoria. J Card Surg. 2011; 26(6): 637-640.
[35]	Hastreiter AR, D'Cruz IA, Cantez T, Namin EP, Licata R. Right-sided aorta. I. Occurrence of right aortic arch in various types of congenital heart disease. II. Right aortic arch, right descending aorta, and associated anomalies. Br Heart J. 1966; 28(6): 722-739.
[36]	Karthekeyan BR, Sundar S, Rao S, Vakamudi M. Management of A Patient with Kommerrell's Aneurysm Causing Tracheal and Esophageal Compression. Indian J Anaesth. 2009; 53(3): 358-361.
[37]	Turkvatan A, Buyukbayraktar FG, Olcer T, Cumhur T. Congenital anomalies of the aortic arch: evaluation with the use of multidetector computed tomography. Korean J Radiol. 2009; 10(2): 176-184.
[38]	Craatz S, Kunzel E, Spanel-Borowski K. Right-sided aortic arch and tetralogy of Fallot in humans--a morphological study of 10 cases. Cardiovasc Pathol. 2003; 12(4): 226-232.
[39]	Chai OH, Han EH, Kim HT, Song CH. Right-sided aortic arch with the retroesophageal left subclavian artery as the fourth branch. Anat Cell Biol. 2013; 46(2): 167-170.
[40]	Ota T, Okada K, Takanashi S, Yamamoto S, Okita Y. Surgical treatment for Kommerell's diverticulum. J Thorac Cardiovasc Surg. 2006; 131(3): 574-578.
[41]	Polguj M, Chrzanowski L, Kasprzak JD, Stefanczyk L, Topol M, Majos A. The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations--a systematic study of 141 reports. Scientific World Journal. 2014; 2014: 292734.
[42]	Patiniotis TC, Mohajeri M, Hill DG. Right aortic arch with aberrant left subclavian artery: aneurysmal dilatation causing symptomatic compression of the right main bronchus in an adult. Aust N Z J Surg. 1995; 65(9): 690-692.
[43]	Arazinska A, Polguj M, Szymczyk K, Kaczmarska M, Trebinski L, Stefanczyk L. Right aortic arch analysis - Anatomical variant or serious vascular defect? BMC Cardiovasc Disord. 2017; 17(1): 102.
[44]	Jakanani GC, Adair W. Frequency of variations in aortic arch anatomy depicted on multidetector CT. Clin Radiol. 2010; 65(6): 481-487.
[45]	Faggioli GL, Ferri M, Freyrie A, et al. Aortic arch anomalies are associated with increased risk of neurological events in carotid stent procedures. Eur J Vasc Endovasc Surg. 2007; 33(4): 436-441.
[46]	Meah VL, Cockcroft JR, Backx K, Shave R, Stohr EJ. Cardiac output and related haemodynamics during pregnancy: a series of meta-analyses. Heart. 2016; 102(7): 518-526.
[47]	Metcalfe J, Ueland K. Maternal cardiovascular adjustments to pregnancy. Prog Cardiovasc Dis. 1974; 16(4): 363-374.