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Eur J Cardiothorac Surg 2007;32:385-387. doi:10.1016/j.ejcts.2007.04.034
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Case reports

Retroesophageal right subclavian artery (lusoria) as origin of traumatic aortic rupture

Jens Schneider*, Reinhard Baier, Christian Dinges, Felix Unger

Department of Cardiac Surgery, St. Johann's University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria

Received 4 March 2007; received in revised form 4 April 2007; accepted 5 April 2007.

* Corresponding author. Address: Universitätsklinik für Herzchirurgie, Müllner Hauptstr. 48, 5020 Salzburg, Austria. Tel.: +43 662 4482 57506; fax: +43 662 4482 3374. (Email: j.schneider{at}salk.at).

A retroesophageal right subclavian artery (lusoria) is unusual for the surgeon, yet common regarding pathological findings (0.5–2%). Complications arising from it are rare (dysphagia). We report a case of traumatic descending aortic tear originating from a lusoria. The patient had experienced chest trauma due to a skiing accident. CT scan revealed an intramural haematoma of the proximal descending aorta. As a coincidence finding, a retroesophageal right subclavian artery was diagnosed. The patient was first treated conservatively. After an initial period—of stable patient conditions—repeated CT scan revealed a haematoma enlargement and surgery was scheduled: A localized aortic tear was suspected through CT scan, yet no aortic tear or flap was visible. During a two-staged surgical procedure, transpositioning of the lusoria into the right common carotid artery was performed, followed by replacement of the distal aortic arch during a second session using a single-branched Dacron tube graft. The left subclavian artery was then reinserted into the side-branched graft after reuptake of extracorporeal circulation. Extracorporeal circulation was applied via the femoral vessels and circulatory arrest in combination with deep hypothermia. After surgery, the patient was stable, having no signs of neurocognitive dysfunction or dysphagia.

Key Words: Lusoria • Retroesophageal right subclavian artery • Traumatic descending aortic tear • Skiing accident






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Copyright © 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.