Anatomic characteristics of the right aortic arch with aberrant left subclavian artery in patients who do and do not undergo vascular ring repair.

Pakaparn Kittichokechai, Shanique Sterling-Lovy, Stuart R Lipsitz, Nao Sasaki, Christopher W Baird, Peter Chiu, Benjamin Zendejas, Robert J Smalley, Daniel A Castellanos
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Abstract

Introduction: It is unclear if certain anatomic characteristics in patients with a right aortic arch with aberrant left subclavian artery (RAA ALSCA) are associated with undergoing surgical repair.

Methods: This was a single-center retrospective study of patients with RAA ALSCA and computed tomography or cardiovascular magnetic resonance from July 2013-September 2023. The size of the proximal ALSCA or diverticulum of Kommerell (DoK), thoracic inlet index, angle of the proximal ALSCA/DoK from the aortic arch, the position of descending aorta, location of the DoK, and tracheal size were compared between patients who did or did not undergo surgery.

Results: Of 163 patients meeting inclusion criteria, 56 ​% underwent surgery. Surgical patients had a larger indexed proximal ALSCA/DoK diameter and area, a higher indexed distance between the tip of the DoK and the opposite aortic wall, a greater proximal-to-distal LSCA ratio, a less acute angle of the proximal ALSCA/DoK from the aortic arch, a more leftward DoK location, and a lower thoracic inlet index compared to non-surgical patients. A larger indexed proximal ALSCA/DoK diameter, with an optimal threshold of ≥13.78 ​mm/m2, and a more leftward DoK location were independently associated with surgery. The reoperation rate was 11 ​%, and was associated with a less acute angle of the proximal ALSCA from the aortic arch.

Conclusions: A larger proximal ALSCA/DoK size and a more leftward DoK location were associated with surgical repair of RAA ALSCA, while a less acute angle of proximal ALSCA from the aortic arch was associated with reoperation.

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右主动脉弓伴左锁骨下动脉异常的解剖特征:行和不行血管环修复术的患者。
目前尚不清楚右主动脉弓伴左锁骨下动脉异常(RAA ALSCA)患者的某些解剖特征是否与手术修复有关。方法:这是一项2013年7月至2023年9月期间RAA ALSCA患者和计算机断层扫描或心血管磁共振的单中心回顾性研究。比较两组患者近端ALSCA或Kommerell憩室(DoK)的大小、胸入口指数、近端ALSCA/DoK与主动脉弓的夹角、降主动脉的位置、DoK的位置和气管大小。结果:163例符合纳入标准的患者中,56%接受了手术。与非手术患者相比,手术患者ALSCA/DoK近端指标性直径和面积更大,DoK尖端与对侧主动脉壁之间的指标性距离更大,LSCA近端与远端比值更大,ALSCA/DoK近端与主动脉弓的夹角更小,DoK位置更左,胸入口指数更低。指数化ALSCA/DoK近端直径较大(最佳阈值≥13.78 mm/m2)和DoK位置偏左与手术独立相关。再手术率为11%,并且与主动脉弓近端ALSCA的锐角较小有关。结论:更大的近端ALSCA/DoK大小和更左的DoK位置与RAA ALSCA的手术修复相关,而距离主动脉弓的近端ALSCA角度较小则与再次手术相关。
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