Mayer Judith, van der Werf-Grohmann Natascha, Kroll Johannes, Spiekerkoetter Ute, Stiller Brigitte, Grohmann Jochen
Judith Mayer, Natascha van der Werf-Grohmann, Ute Spiekerkoetter, Department of Pediatrics and Adolescent Medicine, Freiburg University, 79106 Freiburg, Germany.
World J Cardiol. 2017 Feb 26;9(2):191-195. doi: 10.4330/wjc.v9.i2.191.
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 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 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.
迷走右锁骨下动脉（lusoria动脉）是最常见的先天性根部异常，大多数情况下无症状。然而，20%-40%的患者会出现气管食管症状。我们报告了一名6岁的既往健康女孩，她在4周内出现进行性吞咽困难。包括吞钡检查、超声心动图和磁共振血管造影（MRA）在内的诊断显示，迷走右锁骨下动脉对食管后方造成压迫。尽管成功地通过右侧开胸手术将该lusoria动脉顺利移位至右颈总动脉，但该女孩仍持续存在吞咽困难。再次吞钡检查显示，在lusoria动脉起源处水平，食管仍受到持续压迫。由于MRA未显示横断的血管残端有明显再阻塞的迹象，我们怀疑存在持续的动脉导管韧带。在进行第二次手术干预（左侧开胸手术，包括横断明显持续存在的韧带并缩短迷走右锁骨下动脉的剩余动脉残端）后，患者完全康复。在本病例报告中，我们讨论了持续存在的动脉导管韧带对患有lusoria吞咽困难的左主动脉弓患者的潜在相关性、合理的诊断方法以及预防再次手术的手术选择。
