Tracheal Compression With “Hairpin” Right Aortic Arch: Management by Aortic Division and Aortopexy by Right Thoracotomy Guided by Intraoperative Bronchoscopy

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Tracheal Compression With “Hairpin” Right Aortic Arch: Management by Aortic Division and Aortopexy by Right Thoracotomy Guided by Intraoperative Bronchoscopy Hermes C. Grillo, MD, Cameron D. Wright, MD The Annals of Thoracic Surgery Volume 83, Issue 3, Pages 1152-1157 (March 2007) DOI: 10.1016/j.athoracsur.2006.11.006 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Anatomic features. (AA = ascending aorta, right arch; DA = descending aorta, right side behind AA; DK = diverticulum of Kommerell; E = esophagus; LA = ligamentum arteriosum; LCC = left common carotid; LS = anomalous left subclavian; PA = pulmonary artery; RCC = right common carotid; RS = right subclavian; T = trachea.) (B) Surgical correction. Aortic arch divided beyond RS; lower suture line on DA at site of excision of DK; alternatively DK excision encompassed with excision of short segment of DA; Gore-Tex sling around AA limb and second rib; LS implanted into LCC; LA divided; Dacron graft from AA to DA below hilum. The Annals of Thoracic Surgery 2007 83, 1152-1157DOI: (10.1016/j.athoracsur.2006.11.006) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Angiogram (anterior-posterior view) of patient 2 demonstrating right aortic arch, diverticulum of Kommerell (DK) and aberrant left subclavian artery. (B) Angiogram (lateral view) of patient (2) demonstrating “hairpin” aorta at apex of chest and location of DK. The Annals of Thoracic Surgery 2007 83, 1152-1157DOI: (10.1016/j.athoracsur.2006.11.006) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Chest computed tomography (CT) (axial image) of patient 2 demonstrating markedly compressed and displaced trachea from the aortic arch anomaly. (B) Chest CT (axial image) of patient 2 after operation demonstrating midline trachea of normal diameter. (T = trachea, E = esophagus.) The Annals of Thoracic Surgery 2007 83, 1152-1157DOI: (10.1016/j.athoracsur.2006.11.006) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Chest computed tomography (axial image) of patient 4 demonstrating tracheal compression (teardrop configuration) from the aortic arch anomaly and the diverticulum of Kommerell (DK). The “teardrop” is reversed from what is seen bronchoscopically. The Annals of Thoracic Surgery 2007 83, 1152-1157DOI: (10.1016/j.athoracsur.2006.11.006) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Chest computed tomography (axial image) of patient 4 after operation, demonstrating relief of tracheal compression and Gore-Tex sling around the ascending aorta and the second rib. (GS = Gore-Tex sling.) The Annals of Thoracic Surgery 2007 83, 1152-1157DOI: (10.1016/j.athoracsur.2006.11.006) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions