Left Brachiocephalic Trunk Research Articles

The Right Aortic Arch With Mirror Image Branching: A Case Report

Ali Sami Kivrak, Selcuk Universitesi, Selcuklu Tip Fakultesi, Radyoloji Anabilim Dali Konya, Turkiye. Tel. 0332 2243843 Email. nunver2003@yahoo.com Gelis Tarihi: gg.aa.yyyy • Kabul Tarihi: gg.aa.yyyy ABSTRACT Aortic arc variations may cause some clinical symptoms like dysphagia and stridor or may be determined incidentally. These variations may cause commotions during radiologic examinations and surgical operations. Thus, anatomists, radiologists and surgeons should be aware of them. In this paper, we present a case of a right aortic arch with mirror image branching observed in a computed tomography image of a 50 year-old man. The triple anomaly of the right aortic arch consisted of a left brachiocephalic trunk, the absence of a brachiocephalic trunk on the right side and the separate origins of the arteries on the right side, with the right common carotid artery preceding the right subclavian artery.

Unilateral Pulmonary Artery Agenesis, Angio-MR Findings

A 64-year-old female with no family history of heart disease came to our hospital due to an episode of respiratory superinfection. An x-ray (Fig. 1) showed loss of volume in the left hemithorax and an abnormal cardiac silhouette, so we decided to perform a magnetic resonance (MR) imaging study. Using a 1.5T MR imaging, black blood sequences were acquired in all three imaging planes and a multiphase angiography was performed after administering intravenous contrast (gadolinium). The multiphase MR angiography revealed agenesis of the left pulmonary artery (Fig. 2A) in the pulmonary artery phase. The systemic arterial phase (Fig. 2B) revealed a right aortic arch and left pulmonary arterial vascularization provided by systemic collateral vessels dependent on the left subclavian artery. The supra-aortic trunks originated from a left brachiocephalic trunk that gave rise to the common left carotid artery and the left subclavian artery, and from a right common carotid artery and a right subclavian artery originating independently from the aortic arch (Fig. 2C). The systemic venous phase (Fig. 2D) showed a delay in left pulmonary venous return. Volumetric reconstructions from MR data show, in different obliquities, the morphology of the right ventricular outflow tract, the trunk of the pulmonary artery and the right pulmonary artery (Fig. 3). Multiphase MR angiography, with its high temporal resolution, enables us to obtain anatomical and functional information about thoracic vascular structures with a single injection of intravenous contrast and no ionizing radiation. Figure 3. Figure 1. Figure 2.

Besonderheiten der Kollateralisation bei Patienten mit Verschluss des linken Truncus brachiocephalicus und rechts deszendierender Aorta

A right aortic arch with a left brachiocephalic trunk is a very rare abnormality in the development of the aortic arch and its branches. It accounts for only 0.1 % of all aortic arch abnormalities and is associated in 95 % of all cases with cyanotic heart diseases. At a young age, the latter patients often exhibit pectanginal symptoms (Das SK et al. Byrom Eur J Vasc Endovasc Surg 2005; 30: 48–51). The clinical presentation of the remaining 5 % is non-specific and can result in a subclavian steal syndrome. An association with a patent ductus arteriosus, a left brachiocephalic trunk or other cardiac abnormalities is very common (Singh B. Clin Anat 2001; 14: 47–51). In the case of occlusion of the left brachiocephalic trunk, reactivation of embryonic segmental arteries may result in atypical patterns of collateral vessel pathways with altered cerebrovascular hemodynamics.

Altered Cerebral Collateralization in Patients with Left Brachiocephalic Trunk Occlusion and a Right Descending Aorta

Altered Cerebral Collateralization in Patients with Left Brachiocephalic Trunk Occlusion and a Right Descending Aorta

Leiomiosarcoma primario de mediastino que compromete el sistema de la vena cava superior: Resección quirúrgica asociada a reconstrucción venosa

Primary leiomyosarcoma of the mediastinum involving the superior vena cava system. Surgical resection and venous reconstruction Mediastinal tumors have multiple presentation forms and various pathological origins. Sometimes they reach a large size and can involve the system of superior vena cava by compression or infi ltration. We present a 48 year old man admited for dyspnea, headache and palpitations in decubitus, for the last two months. The X-ray and chest computed tomography showed an anterior mediastinal tumor and the tru-cut pathological study concluded leiomyosarcoma. He underwent surgical treatment; the tumor compromised the system of the superior vena cava and was resected with ligation and resection the left brachiocephalic trunk. Part of the superior vena cava was reconstructed with autologous pericardium. The right phrenic nerve was surrounded by the tumor mass and was resected in block. The patient recovered satisfactorily and was discharged on the eleventh day post surgery. The histopathologic study of the surgical specimen confi rmed a leiomyosarcoma G2 (3,100 gr). Full adjuvant radiotherapy was done. At 15 months after surgery the patient is in good condition without evidence of recurrence or superior vena cava syndrome.

Vascularização arterial dos lobos torácicos do timo em fetos de suínos da Linhagem C40

As origens e distribuições das artérias que vascularizaram os lobos torácicos do timo foram estudadas em fetos de 30 suínos da linhagem C40, sendo 12 machos e 18 fêmeas. Os exemplares tiveram o sistema arterial preenchido com solução aquosa a 50% de Neoprene Látex corado e, em seguida, foram submetidos à fixação em solução aquosa a 10% de formaldeído. Os lobos torácicos do timo foram vascularizados por ramos diretos das artérias torácica interna direita (63,33%) e esquerda (53,33%), subclávia esquerda (3,33%), vertebral esquerda (3,33%), cervical superficial direita (3,33%) e esquerda (3,33%), carótida comum esquerda (3,33%), coronária direita (3,33%) e pelos troncos braquiocefálico (33,33%) e costocervical (3,33%). Observaram-se ainda os ramos indiretos das artérias torácica interna direita (70%) e esquerda (76,67%), subclávia esquerda (23,33%), cervical superficial esquerda (3,33%) e do arco aórtico (6,67%).

Multiple carotid stenting for extended thoracic aorta dissection after initial aortic surgical repair

Acute aortic dissection is one of the most common catastrophes affecting the aorta. Aortic branch occlusion occurs in up to one third of patients with aortic dissection and is associated with increased risk for early death and serious complications. A 67-year-old man without history of cardiovascular disease was referred to our center for acute aortic type A dissection and was treated with a 28-mm Vasculteck prosthesis. During the early postoperative period, he felt left hemiparesis, and an angio-computed tomography showed a progression of the dissection to the right common carotid artery and left brachiocephalic trunk: the abdominal aorta with the celiac trunk. We felt that the patient should receive conservative management, except for the carotid involvement, for which an endovascular approach was planned. After carefully engaging the carotid ostia with a modified no-touch technique, a self-expandable stent and a balloon-expandable stent were deployed to seal the left common and internal carotid artery dissection, whereas two self-expandable stents were implanted within the right internal carotid artery. Angiographic control demonstrated complete sealing of the carotid dissections. The patient recovered quickly after the intervention and was discharged after 2 days without any neurologic or vascular complication. The patient did extremely well at two 3-month follow-ups, and coverage of the descending thoracic aorta dissection was scheduled to be performed in the next 2 months. This case suggests that endovascular techniques may offer a reliable and effective answer to extended dissections, helping decrease the risk for neurologic or visceral complications and reducing the operative risk for further complete surgical or endovascular aortic repair.

Tratamento endovascular da síndrome da veia cava superior: relato de caso e revisão da literatura

Relatamos o caso de uma paciente portadora de síndrome da veia cava superior sintomática de origem benigna tratada pela técnica endovascular. A angiorressonância magnética pré-angioplastia evidenciou extensa trombose do tronco braquiocefálico esquerdo, da veia subclávia esquerda e obstrução da veia cava superior junto ao tronco braquiocefálico direito. A paciente realizou mastectomia radical 2 anos antes, associada à quimioterapia e radioterapia do tórax. Foram realizados angioplastia venosa e implante de stent expansível por balão. O resultado foi satisfatório, com alívio imediato dos sintomas devido à recanalização da veia cava superior e do tronco braquiocefálico direito. Foi instituída anticoagulação oral. A paciente permanece sem recidiva dos sintomas após 8 meses de acompanhamento. O tratamento endovascular é uma alternativa terapêutica com baixa morbidade e resultado satisfatório a médio prazo que pode ser oferecida aos pacientes portadores de síndrome da veia cava superior.

Malformation of the thoracic aorta associated to aneurysms of the arch: an extraanatomic surgical approach

Fig. 1. Angio-MR (a) and DSA of the thoracic aorta (b) show two aneurysms in a right-sided aortic arch. The right common carotid artery takes origin from the ascending aorta; the right subclavian artery and the left brachiocephalic trunk take origin from the descending aorta. A second DSA via interatrial transeptal injection of contrast shows a coarctation with a 100 mmHg gradient of pressure (c) (the arrow indicates the coarctation).

Catheter modification for easier cannulation of the carotid artery during angioplasty and stenting.

To present a modification of both the guiding catheter and stent delivery system to facilitate access into sharply curved supra-aortic vessels during carotid angioplasty. Access failures during carotid interventions typically occur because either the vessel origin is acutely angled or the stenosis is located proximal to the carotid bifurcation, limiting access to the external carotid artery. We directly catheterized the left common carotid artery or brachiocephalic trunk with a guiding catheter whose tip had been curved by steam-shaping. The tip of the stent delivery system also was molded into a curve by this process so it engaged the curved part of the guiding catheter without pulling it out of the vessel. This simple modification can improve the success rate of carotid cannulation via the femoral approach and does not seem to increase the risk of the intervention.

Common arterial trunk associated with absence of one atrioventricular connexion

An unusual case of common arterial trunk is described. The right pulmonary artery is supplied by the ascending trunk and the left pulmonary artery arises via an arterial duct from the left brachiocephalic trunk. Although common arterial trunk can exist with any atrioventricular connexion, the absence of one atrioventricular connexion (tricuspid atresia) is the other rarity of this case.

Visualization of the left superior intercostal vein by MR tomography

A retrospective study of 56 MRT chest examinations showed the left intercostal vein in its horizontal trajectory in 3 patients with left mediastinal masses compressing the superior vena cava. In 2 patients the posterior trajectory of the horizontal segment was clearly visualised. In the third case the anterior part, namely the insertion of the left superior intercostal vein into the left brachiocephalic trunk, was demonstrated.

Two cases of abnormal origins of the left external and internal carotid arteries in the Japanese monkey.

We encountered two cases of abnormal origins of branches arising from the arch of the aorta. That is to say, in the first case, the aortic arch gave directly off the left external carotid artery as its second branch and the left internal carotid artery as its third branch. In the second case, the aortic arch gave directly off the left external carotid artery as its second branch and the left brachiocephalic trunk dividing into the left internal carotid and the left subclavian artery as its last branch. In both cases the right brachiocephalic trunk arose normally as the first branch of the aortic arch. In the first case the left subclavian artery was the last branch of the aortic arch.It is conjectured that those anomalies were caused by the disappearance of the left third aortic arch and the persistence of the left carotid duct during the embryonic period.