Julia Dumfarth, MD, Alan S. Chou, BA, Bulat A

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Presentation transcript:

Atypical aortic arch branching variants: A novel marker for thoracic aortic disease Julia Dumfarth, MD, Alan S. Chou, BA, Bulat A. Ziganshin, MD, Rohan Bhandari, MS, Sven Peterss, MD, Maryann Tranquilli, RN, Hamid Mojibian, MD, Hai Fang, PhD, John A. Rizzo, PhD, John A. Elefteriades, MD The Journal of Thoracic and Cardiovascular Surgery Volume 149, Issue 6, Pages 1586-1592 (June 2015) DOI: 10.1016/j.jtcvs.2015.02.019 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Aortic arch branching patterns: normal branching variant of the aortic arch, bovine aortic arch variant, isolated left vertebral artery variant, and aberrant right subclavian artery. 1 = Brachiocephalic artery. 2 = Left common carotid artery. 3 = Left subclavian artery. 4 = Right common carotid artery. 5 = Left vertebral artery. 6 = Aberrant right subclavian artery. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1586-1592DOI: (10.1016/j.jtcvs.2015.02.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Modified Forest plot of percent of patients with normal arch branching pattern. Note the much lower frequency of normal branching pattern in the patients with thoracic aortic disease (TAD) compared with the normal populations. This is a visual representation of the data from Table 1. This was done by depicting the data from each study by a square located at the proper percent line for each study, and with a weighted square size for the number of patients studied. The diamond represents the average of all 4 studies of the normal population. The Yale study of the TAD population is represented by the red square. The confidence limits for the studies from the literature were not available, so no formal Forest plot statistical calculations could be done. The applicable statistics are those from Table 1. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1586-1592DOI: (10.1016/j.jtcvs.2015.02.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Different location of the origin of isolated left vertebral artery (LVA) (red arrow). A, LVA originating directly from the aortic arch distal to the left subclavian artery (LSA). B, LVA originating from the aortic arch between the left common carotid artery (LCA) and the LSA. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1586-1592DOI: (10.1016/j.jtcvs.2015.02.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Arch branching: normal, bovine arch, isolated left vertebral artery, aberrant right subclavian artery. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1586-1592DOI: (10.1016/j.jtcvs.2015.02.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions