Clinical study of right aortic arch and left artery ligament

Abstract

Objective To explore the diagnosis and surgical treatment of patients with right aortic arch and left artery ligament. Methods The clinical data of 64 patients with right aortic arch left arterial ligament were analyzed retrospectively from January 1, 2008 to April 1, 2017. There were 43 boys and 21 girls with an average age of (9.87±11.12) months and an average body weight of (6.52±4.07) kg. Among 39 cases of right aortic arch and aberrant left subclavian artery, significant Kommerell diverticulum was concurrent in 12 cases, including mirror branch type A (n=23) and mirror branch B type (n=2). Except for mirror branch of children with type B without obvious respiratory and gastrointestinal symptoms, all children were operated. The cases of aberrant left subclavian artery and mirror branch A underwent simple arterial ligament dislocation plus significant Kommerell diverticulum under left subclavian artery transplantation, correction of of vagal left subclavian artery malformations and diverticulotomy. Results All children were successfully operated. Wheezing and gastrointestinal symptoms became significantly relieved. There was no chylothorax, diaphragmatic or paralytic nerve injury. The average ventilator support duration was (24.18±21.32)(2-48) h. The average stay duration of intensive care unit (ICU) was (53.24±20.57)(24-72) hours and it was not significantly different from that of other children during the same period. Discharge occurred after 7-10 days. For 42 cases, the follow-up period was 3 to 7 months. All wheezing symptoms gradually disappeared. Enhanced computed tomography (CT) revealed no abnormality of subclavian artery, aortic arch or bilateral upper extremity arteries. Conclusions Right aortic arch and left artery ligament should be operated promptly after a definite diagnosis through enhanced cardiac CT and fiberoptic bronchoscopy. Surgery is indicated for relieving tracheal compression symptoms in children. Timely release of compressing vascular ring on trachea and esophagus is vital for improving the prognosis. Key words: Aortic arch; Subclavian artery; Tracheal stenosis