title: Dysphagia after arteria lusoria dextra surgery: Anatomical considerations before redo-surgery.
abstract: Aberrant right subclavian artery (arteria lusoria) is the most common congenital root anomaly, remaining asymptomatic in most cases. Nevertheless, some of the 20%-40% of those affected present tracheo-esophageal symptoms. We report on a 6-year-old previously healthy girl presenting with progressive dysphagia over 4 wk. Diagnostics including barium swallow, echocardiography and magnetic resonance angiography (MRA) revealed a retro-esophageal compression by an aberrant right subclavian artery. Despite the successful, uneventful transposition of this arteria lusoria to the right common carotidviaright-sided thoracotomy, the girl was suffering from persisting dysphagia. Another barium swallow showed the persistent compression of the esophagus on the level where the arteria lusoria had originated. As MRA showed no evidence of a significant re-obstruction by the transected vascular stump, we suspected a persisting ligamentum arteriosum. After a second surgical interventionvialeft-sided thoracotomy consisting of transecting the obviously persisting ligamentum and shortening the remaining arterial stump of the aberrant right subclavian artery, the patient recovered fully. In this case report we discuss the potential relevance of a persisting ligamentum arteriosum for patients with left aortic arch suffering from dysphagia lusoria and rational means of diagnosing, as well as the surgical options to prevent re-do surgery.
authors.affiliation: Judith Mayer, Natascha van der Werf-Grohmann, Ute Spiekerkoetter, Department of Pediatrics and Adolescent Medicine, Freiburg University, 79106 Freiburg, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Mayer
authors.affiliation: Judith Mayer, Natascha van der Werf-Grohmann, Ute Spiekerkoetter, Department of Pediatrics and Adolescent Medicine, Freiburg University, 79106 Freiburg, Germany.
authors.forename: Natascha
authors.initials: N
authors.lastname: van der Werf-Grohmann
authors.affiliation: Judith Mayer, Natascha van der Werf-Grohmann, Ute Spiekerkoetter, Department of Pediatrics and Adolescent Medicine, Freiburg University, 79106 Freiburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kroll
authors.affiliation: Judith Mayer, Natascha van der Werf-Grohmann, Ute Spiekerkoetter, Department of Pediatrics and Adolescent Medicine, Freiburg University, 79106 Freiburg, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Spiekerkoetter
authors.affiliation: Judith Mayer, Natascha van der Werf-Grohmann, Ute Spiekerkoetter, Department of Pediatrics and Adolescent Medicine, Freiburg University, 79106 Freiburg, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Stiller
authors.affiliation: Judith Mayer, Natascha van der Werf-Grohmann, Ute Spiekerkoetter, Department of Pediatrics and Adolescent Medicine, Freiburg University, 79106 Freiburg, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Grohmann
keywords: Arteria lusoria dextra; Dysphagia; Persisting ligamentum arteriosum; Redo-surgery; Retroesophageal compression