Single-stage total correction of severe aortic stenosis and dysphagia lusoria via a single extended median sternotomy: a case report

Aberrant right subclavian artery (ARSA) is the most common anomaly of the aortic arch and is usually asymptomatic. In a minority of patients, ARSA may cause dysphagia due to esophageal compression (dysphagia lusoria). The coexistence of symptomatic ARSA and severe aortic stenosis requiring surgical treatment is extremely rare, and the optimal management strategy remains unclear. A 43-year-old woman presenting with acute decompensated heart failure was diagnosed with severe aortic stenosis and concomitant dysphagia lusoria. Following medical stabilization in the intensive care unit, she underwent a single-stage total correction. To minimize surgical trauma and avoid multiple incisions, a conventional median sternotomy was slightly extended into the right supraclavicular region, serving as a single unified incision. Through this approach, transposition of the ARSA to the right common carotid artery was performed first, followed by mechanical aortic valve replacement with bovine pericardial patch repair of a focal annular defect secondary to decalcification and primary closure of a patent foramen ovale. Postoperatively, valve hemodynamics improved markedly, and dysphagia resolved completely, leading to a significant recovery of the patient's nutritional status. This case demonstrates that a single-stage, single-incision approach is a highly effective and viable strategy, providing valuable clinical insight into the management of these combined rare pathologies.