Aberrant right subclavian artery is the most common congenital anomaly of the aortic arch and may present with dysphagia lusoria due to esophageal compression. Although bicuspid aortic valve disease is commonly associated with aortopathy, its coexistence with an aberrant right subclavian artery and a contralateral subclavian artery aneurysm is exceedingly rare. We report the case of a 33-year-old male presenting with exertional dyspnea, chest pain, presyncope, and intermittent dysphagia to solids. Echocardiography demonstrated severe bicuspid aortic stenosis with a mean gradient of 95 mmHg and a peak velocity of 7.6 m/s. Computed tomography angiography revealed a retroesophageal aberrant right subclavian artery and a 34 mm aneurysm of the left subclavian artery. Following multidisciplinary discussion, the patient underwent a single-stage hybrid procedure consisting of right carotid-subclavian bypass and translocation of the aberrant vessel via a supraclavicular approach, followed by mechanical aortic valve replacement through median sternotomy. The postoperative course was complicated by transient complete heart block, which resolved spontaneously before discharge. Follow-up imaging demonstrated a patent bypass graft and stable aneurysm size, while dysphagia resolved completely. This case highlights the importance of investigating dysphagia in young adults with congenital valvular disease and demonstrates the value of individualized hybrid surgical strategies in complex arch pathology. The management of a contralateral subclavian artery aneurysm in the setting of bicuspid aortic valve aortopathy remains a clinical dilemma without clear guideline thresholds.
Ullah et al. (Tue,) studied this question.