Dysphagia Lusoria with atrial septal defect: Simultaneous repair through midline
A four-year-old female child presented to us with complaints of dysphagia and regurgitation of solid food. A contrast-enhanced CT scan (CECT) of the chest done elsewhere revealed an aberrant right subclavian artery []. A 256 slice CECT scan was ordered in our hospital for the exact anatomical characterization of the aberrant vessel. The scan showed an aberrant origin of the right subclavian artery from the medial wall of the descending thoracic aorta, just distal to the origin of the left subclavian artery [Figures and ]. The artery crossed to the right side at the level of the fourth thoracic vertebra, causing posterior compression of the esophagus. An additional finding that was noted was the common origin of the right and left common carotid arteries. The arch was left-sided, with a left descending thoracic aorta. An echocardiogram done showed a large ostium secundum atrial septal defect (ASD) of 20 mm, with a dilated right atrium and right ventricle.\nUnder general anesthesia a median sternotomy was performed. The arch was followed down from the top and the aberrant right subclavian artery was identified just distal to the origin of the left subclavian artery on the medial wall of the descending thoracic aorta. Loss of the right radial artery trace on clamping the aberrant vessel confirmed that the vessel was indeed the right subclavian artery. The artery was carefully divided at its site of origin and the aortic end oversewn with two layers of continuous polypropylene sutures. The artery was next brought to the right side from behind the esophagus and the anastomosed end side to the right common carotid artery, after confirming that there was no torsion of the mobilized vessel []. Pericardial patch closure of the ostium secundum ASD was performed in a routine manner, under cardiopulmonary bypass, under mild hypothermia using the standard cannulation techniques. The patient had an uneventful postoperative course and was discharged on day six from the hospital. The patient had no complaints of dysphagia or regurgitation of food on discharge.