(I-1B.3) Adult patient with vascular ring Lidia Tomkiewicz-Pająk MD PhD, Natalia Dłużniewska MD, Leszek Drabik MD PhD, Prof Maria Olszowska MD, PhD, Prof Piotr Podolec MD PhD
Experts: Prof Piotr Pieniążek MD PhD, Jacek Pajak MD PhD, Anna Prokop-Staszecka Prof. Piotr Podolec MD, PhD

 

BRIEF COMMENTS

EXPERT: Prof. Roland Hetzer, MD PhD, cardiac surgeon Affiliation: Deutsches Herzzentrum, Berlin, Germany

COMMENT This rare condition is called arteria subclavia lusoria. It may cause stridor due to compression. Dilated proximal segment of descending aorta – so called Diverticulum, is the place where the aneurysm develops. Obstruction of trachea might in this case be caused as well by Diverticulum not artery itself. Operation should be performed: reduction of Diverticulum and transposition of artery to the proper position. Diverticulum is placed between trachea and oesophagus causing compression. During a surgery, a clamp on descending aorta allows to transmit the artery or do a graft with carotid artery. Diverticulum needs operation as it cause symptoms usually in older patients – adolescent/young adults. As well, in older patients dissection of diverticulum may appear.

EXPERT: Prof. Bogusław Kapelak, MD PhD, cardiac surgeon Affiliation: Department of Cardiovascular Surgery and Transplantation, John Paul II Hospital, Krakow, Poland

COMMENT I am doubtful, whether symptoms presented by the patient have strictly somatic origin. The surgery might not therefore, improve the quality of life.

EXPERT: Dr Jacek Kolcz, MD PhD, pediatric cardiac surgeon Affiliation: Department of Pediatric Cardiac Surgery, University Children’s Hospital of Krakow, Poland

COMMENT I suggest to perform more pneumologic tests in order to prove whether there is an obstruction of bronchi. The diverticulum on the other hand, is usually eliminated because of the danger of dissection.

EXPERT: Dr Lidia Tomkiewicz-Pająk, MD PhD, cardiologist Affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland

COMMENT The tests performed previously prove that there is an asthma, no bronchial obstruction by the subclavian artery.

EXPERT: Prof. Piotr Podolec, MD PhD, cardiologist Affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland

COMMENT Opinion regarding further management is controversial. Further evaluation and follow up is required. Decision regarding the management should be made with close cooperation with patient, surgeons, and cardiologists.

 

CONCLUSION

Surgical treatment of diverticulum appears to be reasonable option. Patients inform consent is however required prior the final decision.

 


“Development of the European Network in Orphan Cardiovascular Diseases”
„Rozszerzenie Europejskiej Sieci Współpracy ds. Sierocych Chorób Kardiologicznych”

This entry was posted in 1. Anatomical malformations of the arteries, 3. Aortic rings, B. Aorta and aortic arch main branches, Case presentations, I. Rare diseases of systemic circulation. Bookmark the permalink.

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