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BACKGROUND/AIM Right aortic arch (RAA) is a rare abnormality of the aortic arch that forms a vascular ring. Oesophageal cancer (EC) accompanied with RAA is even rarer, and in such cases, it is very important to understand the anatomical structure in the upper mediastinum in order to perform a safe and curative operation. PATIENTS AND METHODS A 67-year-old man who presented with pharyngeal discomfort was admitted to our hospital. Further examinations revealed advanced thoracic EC accompanied with RAA and aortic diverticulum. RESULTS After neoadjuvant chemotherapy, we successfully and safely performed thoracoscopic oesophagectomy and lymphadenectomy using the prone positioning. CONCLUSION There exist only a few reports of thoracoscopic oesophagectomy for EC with RAA. Sufficient preoperative preparation and sharing an adequate strategy for the surgical approach with the surgical team are definitely necessary. Although the thoracoscopic approach for EC with RAA is useful, more considerations are needed for some issues.

1. Cina CS, Althani H, Pasenau J, Abouzahr L. Kommerell’s diverticulum and right-sided aortic arch: a cohort study and review of the literature. J Vasc Surg. 2004;39:131-9. 2. Kapustin AJ, Litt HI. Diagnostic imaging for aortic dissection. Semin Thorac Cardiovasc Surg. 2005;17:214-23. 3. Flachskampf FA. Assessment of aortic dissection and hematoma. Semin Cardiothorac Vasc Anesth. 2006;10:83-8. 4. Eltzschig HK, Rosenberger P, Lekowski RW Jr, Scott JD, Locke A, Shekar PS, et al. Role of transesophageal echocardiography in patients with suspected aortic dissection. J Am Soc Echocardiogr. 2005;18: 1221. 5. Ko SF, Ng SH, Fu M, Lo PH, Cheng YF, Lee TY. Dissection of retroesophageal aortic diverticulum and descending aorta in a patient with right aortic arch: magnetic resonance demonstration. Cardiovasc Intervent Radiol. 1996;19:438-41.

A 32-year-old woman was referred for evaluation of a 3-year history of exertion dyspnea. An anomalous vascular ring created by a right aortic arch with mirror-image branching, left descending aorta, and aortic diverticulum narrowed the trachea circumferentially. This feature was surgically approached through a right posterolateral thoracotomy, and simple amputation of the aortic diverticulum resulted in immediate symptomatic relief.

The anatomy of the aberrant left subclavian artery in a right-sided aortic arch is different in patients with tetralogy of Fallot than in persons with a normal heart. In all eight patients with tetralogy of Fallot and aberrant left subclavian artery in this series, the left subclavian artery arose directly from the distal aortic arch. In contrast, normal persons with right aortic arch and aberrant left subclavian artery invariably have an aortic diverticulum from which the left subclavian artery and the left ductus arteriosus originate. The possible different embryologic events responsible for these two forms of aberrant left subclavian artery are discussed.

The aortic diverticulum, a large bulge on the lesser curvature of the aortic isthums, is an occasional variation found during thoracic aortography in patients with a left aortic arch and normal origin of the brachiocephalic arteries. Although it is commonly thought to be a remnant of the closed ductus arteriosus, the results of this study support the hypothesis that it is a remnant of the right dorsal aortic root.

This is the first clinical and angiographic description of congenital subclavian steal in a patient with left aortic arch, isolation of the right subclavian artery, and an aortic diverticulum.

Summary The authors record a case of congenital hemihypertrophy in a woman of 24 years. Diagnosis is usually made earlier in infancy or childhood. The principal features of this curious malformation are described. Associated malformations are common. In the present case, a particular malformation is stressed, namely an abnormality of the aortic arch with a right-sided aorta and low implantation of the left subclavian artery which arose from an aortic diverticulum. Another interesting point is the presence of anomalies of the extremities, brachydactyly, and syndactyly. Cutaneous and ocular anomalies are more common and the condition appears to be related to phacomatosis. The different theories of the pathogenesis of the condition are discussed.

DIVERTICULA of the aortic arch are rare congenital anomalies found as a component of vascular rings in infants. They may occur with either a right or a left aortic arch and represent persistence of the contralateral dorsal aortic root1 (Fig. 1). There are several reports concerning their diagnosis in adults by means of routine roentgenographic studies of the chest.1 2 3 4 5 6 However, angiographic studies of such patients have rarely been reported. The purpose of this paper is to describe 4 patients, each referred for the evaluation of a mediastinal mass, in whom angiography demonstrated the presence of an aortic diverticulum. One of . . .