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J Thorac Cardiovasc Surg 2007;134:235-236
© 2007 The American Association for Thoracic Surgery

Brief Communication

Complete vascular ring presenting in adulthood: An unusual management dilemma

Edward J. Hickey, MD, Aftab Khan, MRCS, David Anderson, FRCS, Loic Lang-Lazdunski, FRCS*

Department of Thoracic Surgery, Guy’s Hospital, King’s College London, London, United Kingdom.

Received for publication January 3, 2007; accepted for publication January 31, 2007.

* Address for reprints: Loic Lang-Lazdunski, MD, PhD, FRCS, Department of Thoracic Surgery, Guy’s Hospital, King’s College Hospital, St Thomas St, London SE1 9RT, United Kingdom. (Email: loic.lang-lazdunski@gstt.nhs.uk).

The first 20% of the full text of this article appears below.

Clinical Summary

Patient 1
An otherwise fit 47-year-old woman presented with progressive dyspnea and wheeze on minimal exertion over several years. After a negligible response to bronchodilators, bronchoscopy demonstrated extrinsic compression causing midtracheal collapse. A computed tomographic (CT) scan indicated a right-sided aortic arch with a Kommerell diverticulum and a retroesophageal left subclavian artery (Figure 1). She underwent a left posterior lateral thoracotomy through the fifth intercostal space. The ligamentum arteriosum (completing the type 3 ring) appeared to be the principal cause of tracheal compromise and was divided to achieve complete decompression. Recovery was uneventful, and she is symptom-free 12 months later.


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  		Figure 1. Axial computed tomographic scan through T4 showing a right-sided aortic arch (RAo) compressing the anterolateral aspect of the trachea. The aberrant left subclavian artery is not visible on this scan but arose from the Kommerell diverticulum. IVC, Inferior vena cava; IV, innominate vein.

 
Patient 2
A 37-year-old female nonsmoker described limited exercise tolerance and exertional wheeze since childhood. Medical attention was sought only after significant symptom exacerbation during pregnancy. . . . [Full Text of this Article]




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