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Retroesophageal Right Aortic Arch Associated with an Aortic Aneurysm and a Ventricular Septal Defect

  • Marcus Vinícius Silva Ferreira
  • Gabrielle Santos Oliveira
  • Ana Carolina Gonçalves e Silva
  • Fernando Antibas Atik
  • Cláudio Ribeiro da Cunha
Chapter

Abstract

This chapter presents the case of a patient admitted due to complaints of shortness of breath and chest pain upon exertion radiating to the back and episodes of tachycardia, with a perimembranous VSD on transthoracic echocardiography and a retroesophageal right aortic arch with anomalous left subclavian artery and a compressive saccular aneurysm on CT scan. Surgical correction was made with an interposition of a Dacron graft creating an aortic bypass from the ascending aorta to the retroesophageal portion of the aorta and a ventricular septoplasty. After surgery, the patient was admitted to the ICU henodinamically stable under 7 mcg/kg/min of dobutamine and 0.4 mcg/kg/min of nitroprusside, which were totally weaned after 24 h. After 29 days, the patient was discharged and followed up until complete remission of chest pain and improvement of respiratory symptoms were noted. This case brings the discussion about vascular rings and how to manage them. From their embryonic formation to associated anatomical anomalies, we dissect their anatomical features and their clinical presentation, which may depend upon their type, severity, and associated anomalies. Followed by its propedeutics, we present how clinical investigation should proceed, when to best indicate an imaging study depending upon clinical presentation, and when to surgically intervene.

Bibliography

  1. 1.
    de Gomma EM, Wright CD, Pelikan PC, Leal JE, Karlsberg RP. Surgically corrected right-sided aortic arch. J Am Coll Cardiol. 2011;57(23):2375.CrossRefGoogle Scholar
  2. 2.
    Galindo A, Nieto O, Nieto MT, Rodríguez-Martín OM, Herraiz I, Escribano D, Granados MA. Prenatal diagnosis of right aortic arch: associated findings, pregnancy outcome, and clinical significance of vascular rings. Prenat Diagn. 2009;29:975–81.CrossRefGoogle Scholar
  3. 3.
    Hardin RE, Brevetti GR, Sanusi M, Bhaskaran D, Burack JR, Genovesi MH, Lowery RC, Rafii S, Bondi E. Treatment of symptomatic vascular rings in the elderly. Tex Heart Inst J. 2005;32(3):411–5.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Konstantinov IE, Puga FJ. Surgical treatment of persistent esophageal compression by an unusual form of right aortic arch. Ann Thorac Surg. 2001;72:2121–3.CrossRefGoogle Scholar
  5. 5.
    Licari A, Rispoli GA, Mannarino S, Pelizzo G, Marseglia GL. Congenital vascular rings: a clinical challenge for the pediatrician. Pediatr Pulmonol. 2015;50:511–24.CrossRefGoogle Scholar
  6. 6.
    Mann DL, Zipes DP, Libby P. Braunwald’s heart disease: a textbook of cardiovascular medicine. 10th ed. Philadelphia: Saunders Elsevier; 2015.Google Scholar
  7. 7.
    McElhinney DB, Clark BJ, Weinberg PM, Kenton ML, McDonald-McGinn D, Driscoll DA, Zackai EH, Goldmuntz E. Association of chromosome 22q11 deletion with isolated anomalies of aortic arch laterality and branching. J Am Coll Cardiol. 2001;37(8):2114–9.CrossRefGoogle Scholar
  8. 8.
    Moore KL, Persaud TVN, Torchia MG. The developing human: clinically oriented embryology. 9th ed. Philadelphia: Saunders Elsevier; 2013.Google Scholar
  9. 9.
    Suh YJ, Kim GB, Kwon BS, Bae EJ, Noh CI, Lim HG, Kim WH, Lee JR, Kim YJ. clinical course of vascular rings and risk factors associated with mortality. Korean Circ J. 2012;42:252–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Marcus Vinícius Silva Ferreira
    • 1
  • Gabrielle Santos Oliveira
    • 1
  • Ana Carolina Gonçalves e Silva
    • 1
  • Fernando Antibas Atik
    • 1
  • Cláudio Ribeiro da Cunha
    • 1
  1. 1.Cardiology Institute of Federal District (ICDF)BrasíliaBrazil

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