Aberrant right subclavian artery: an impediment to transesophageal echocardiography
- PDF / 388,750 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 94 Downloads / 193 Views
IMAGES
Aberrant right subclavian artery: an impediment to transesophageal echocardiography . Hilary P. Grocott, MD, FRCPC, FASE . Megan Deck, MD Michael H. Yamashita, MDCM, MPH, FRCSC Received: 25 September 2020 / Revised: 25 September 2020 / Accepted: 4 October 2020 Ó Canadian Anesthesiologists’ Society 2020
An aberrant right subclavian artery (ARSA), where the vessel arises directly from the aorta just distal to the takeoff of the left subclavian artery (i.e., proximal descending aorta), is the most common congenital variant of the aortic arch, occurring in 0.5–2.5% of individuals.1 In 80% of cases, the ARSA is in a retro-esophageal position with the esophagus located between the ARSA and the trachea. An ARSA is generally an asymptomatic finding, although 10% of patients may experience symptoms of tracheoesophageal compression (e.g., dysphagia) later in life, in part related to increased vessel wall rigidity or aneurysmal development.2 Compression of the ARSA (with impairment in right radial arterial blood pressure monitoring) has also been reported during transesophageal echocardiography (TEE).3 Herein, we report our experience in an 80-yr-old female (who consented to this report) who presented for an Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-020-01837-8) contains supplementary material, which is available to authorized users.
elective ascending and hemi-arch replacement of an ascending aortic aneurysm and aortic valve replacement for severe aortic regurgitation. Her preoperative chest computed tomography (CT) scan revealed an incidental and asymptomatic finding of a retroesophageal ARSA. After induction of anesthesia, a TEE probe was attempted to be inserted but met significant resistance in the upper esophagus and could not be advanced beyond 20 cm; the TEE insertion was thus abandoned. Further inspection of the preoperative chest CT scan revealed significant compression of the esophagus by a heavily calcified ARSA (Figure A and B; eVideo in the Electronic Supplementary Material), which likely prevented the advancement of the TEE probe. The case proceeded uneventfully without the use of TEE, and the patient’s postoperative course was uncomplicated. The presence of an ARSA should alert an echocardiographer to the possibility of difficulty with completing a TEE examination.
M. Deck, MD (&) Department of Anesthesiology, Perioperative & Pain Medicine, University of Saskatchewan, Saskatoon, SK, Canada e-mail: [email protected] H. P. Grocott, MD, FRCPC, FASE Department of Anesthesiology, Perioperative & Pain Medicine, University of Manitoba, Winnipeg, MB, Canada Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, MB, Canada
MichaelH. Yamashita, MDCM, MPH, FRCSC Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, MB, Canada Division of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
123
M. Deck et al. Disclosures
None.
Funding statement
None.
Editorial responsibilit
Data Loading...
