title: Primary translocation of aberrant left subclavian artery for children with symptomatic vascular ring.
abstract: BACKGROUND
  The standard operation for vascular ring with right aortic arch and aberrant left subclavian artery is ligamentum arteriosum division. A new surgical approach with primary translocation of the aberrant left subclavian artery to the left carotid artery, removal of the Kommerell diverticulum, and division of the ligamentum through left thoracotomy was recently applied. This study assessed the early outcomes of this approach.
  
  
  METHODS
  This is a retrospective review of all patients having an operation for right aortic arch with aberrant left subclavian artery and the Kommerell diverticulum between January 2001 and April 2011 at a single institution.
  
  
  RESULTS
  Eight patients had a division of the ligamentum and 10 had a primary translocation of an aberrant left subclavian artery with diverticulum removal and ligamentum division. The median operative age and weight for each surgical technique group were, respectively, 2.2 and 1.8 years (p = 0.56) and 10.7 and 12.6 kg (p = 0.30). All patients were symptomatic preoperatively. No deaths occurred. One patient from each group had chylous effusion that was medically treated. The median hospital stay for each group was 4 and 5 days (p = 0.45). During the median follow-up of 47 months, 3 patients in the division of ligamentum group required albuterol aerosol or oral antiinflammatory medication for respiratory symptoms. All patients in the primary translocation group remained asymptomatic and required no medication (p = 0.069).
  
  
  CONCLUSIONS
  Primary translocation of aberrant left subclavian artery with removal of the diverticulum and division of the ligamentum had excellent early outcomes and can potentially eliminate residual symptoms and late complications.
authors.affiliation: Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202, USA. tshinkawa@uams.edu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shinkawa
authors.forename: S Bruce
authors.initials: SB
authors.lastname: Greenberg
authors.forename: Robert D B
authors.initials: RD
authors.lastname: Jaquiss
authors.forename: Michiaki
authors.initials: M
authors.lastname: Imamura
mesh_terms: D000783:Aneurysm / Q000175:diagnosis / Q000601:surgery*; D001015:Aortic Arch Syndromes / Q000175:diagnosis / Q000601:surgery*; D018376:Cardiovascular Abnormalities / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000175:diagnosis / Q000601:surgery*; D004240:Diverticulum / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000002:abnormalities / Q000601:surgery*; D016896:Treatment Outcome; D054079:Vascular Malformations