Coarctation of the aorta with right aortic arch and isolation of the left innominate artery: A surgical challenge in a patient without collateral posterior.

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Presentation transcript:

Coarctation of the aorta with right aortic arch and isolation of the left innominate artery: A surgical challenge in a patient without collateral posterior brain circulation C. Delgado, MD, PhD, F. Barturen, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 116, Issue 4, Pages 657-659 (October 1998) DOI: 10.1016/S0022-5223(98)70179-5 Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1 Left, Aortic arch angiogram in right anterior oblique position. The film demonstrates a right-sided aortic arch with 3 vessels arising from the arch in the following order: right common carotid (straight arrow), right vertebral (arrowhead), and right subclavian (doubled arrowhead) arteries. Delayed retrograde opacification of the left vertebral (open arrow), left common carotid (small arrows), and left subclavian (double arrow) isolated arteries were observed on the same film. Underdevelopment of the right and left thoracic arteries can also be seen (>>). Catheter tip is in ascending aorta. Right, Diagram showing the development of type AD right aortic arch: A, The hypothetical double arch of Edwards.5 B, Interruption of the left arch in zones A and D. C, Transformation of the left arch into an isolated left innominate artery (arrow). AA, Ascending aorta; DA, descending aorta; LCCA, left common carotid artery; RCCA, right common carotid artery; Ida, left ductus arteriosus; LSA, left subclavian artery; RSA, right subclavian artery; RVA, right vertebral artery. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 657-659DOI: (10.1016/S0022-5223(98)70179-5) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1 Left, Aortic arch angiogram in right anterior oblique position. The film demonstrates a right-sided aortic arch with 3 vessels arising from the arch in the following order: right common carotid (straight arrow), right vertebral (arrowhead), and right subclavian (doubled arrowhead) arteries. Delayed retrograde opacification of the left vertebral (open arrow), left common carotid (small arrows), and left subclavian (double arrow) isolated arteries were observed on the same film. Underdevelopment of the right and left thoracic arteries can also be seen (>>). Catheter tip is in ascending aorta. Right, Diagram showing the development of type AD right aortic arch: A, The hypothetical double arch of Edwards.5 B, Interruption of the left arch in zones A and D. C, Transformation of the left arch into an isolated left innominate artery (arrow). AA, Ascending aorta; DA, descending aorta; LCCA, left common carotid artery; RCCA, right common carotid artery; Ida, left ductus arteriosus; LSA, left subclavian artery; RSA, right subclavian artery; RVA, right vertebral artery. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 657-659DOI: (10.1016/S0022-5223(98)70179-5) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig 2 Sequential posteroanterior angiograms with catheter tip in proximal right vertebral artery (a, b, c, and d). The films demonstrate retrograde opacification of left vertebral artery across the vertebrobasilar junction and by muscular collateral vessels in the neck. The absence of a posterior communicating artery can also be suspected. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 657-659DOI: (10.1016/S0022-5223(98)70179-5) Copyright © 1998 Mosby, Inc. Terms and Conditions