Aberrant Subclavian Artery Repair With VSD and ASD Closure
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Abberent subclavian artery is the rare anatomical variation of aortic arch where the right subclavian artery origin is distal to the left subclavian artery. Its way to the right arm crosses the midline posterior to the esophagus. Operative approach and timing to correct this condition has not been well-defined.
A muscle-sparing right thoracotomy was used in pediatrics to avoid vagus and laryngeal nerve injury. The supraclavicular approach is for adults. Left thoracotomy and sternotomy are also used for selected cases. Children are usually asymptomatic and usually present with dypnoea, then dysphagea and Ortner's syndrome is the rare presentation, where compression is recurrent in the laryngeal nerve.
The authors present the case of a 3-month-old child with failure to thrive, breathlessness, and repeated respiratory tract infection. The X-ray was suggestive of aspiration in the right lungs. Echo showed large VSD and ASD and severe PAH. Cardiac cath showed unusual branching of the aortic arch. Both carotid and subclavian were arising separately. Computed tomography (CT) showed anomalous right subclavian artery from the arch of the aorta, seen distal to the left subclavian artery and superior to the esophagus to reach right side. There was some evidence of esophageal compression as the segment proximal to the right subclavian artery crossing appeared dilated. The child underwent abarrent right subclavian artery repair - reimplantation of the right subclavian artery with ASD and VSD closure. The postoperative period was uneventful, and the patient was extubated after three days. There was no feed intolarance or aspiration, no evidence of recurrent laryngeal nerve injury/into the right carotid artery, or Horner's syndrome/thoracic duct injury. There was no pressure difference in the arms, and echo revealed good surgical correction.