array:25 [
  "pii" => "S0870255119305955"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2017.07.023"
  "estado" => "S300"
  "fechaPublicacion" => "2019-10-01"
  "aid" => "1462"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2019"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "crp"
  "cita" => "Rev Port Cardiol. 2019;38:737.e1-737.e4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 198
    "formatos" => array:3 [
      "EPUB" => 34
      "HTML" => 125
      "PDF" => 39
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S2174204920300131"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2020.01.010"
      "estado" => "S300"
      "fechaPublicacion" => "2019-10-01"
      "aid" => "1462"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "crp"
      "cita" => "Rev Port Cardiol. 2019;38:737.e1-737.e4"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 24
        "formatos" => array:3 [
          "EPUB" => 2
          "HTML" => 18
          "PDF" => 4
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
        "titulo" => "Dissected aberrant right subclavian artery with Kommerell diverticulum"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "737&#46;e1"
            "paginaFinal" => "737&#46;e4"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Art&#233;ria subcl&#225;via direita aberrante dissecada com divert&#237;culo de Kommerell"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figure 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 1786
                "Ancho" => 1500
                "Tamanyo" => 247060
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Postoperative computed tomography angiography showing the graft implanted in the thoracic aorta&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Carlos Dom&#237;nguez-Massa, Alberto Berbel-Bonillo, Manuel P&#233;rez-Guillen, Jos&#233; A&#46; Montero-Argudo"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Carlos"
                "apellidos" => "Dom&#237;nguez-Massa"
              ]
              1 => array:2 [
                "nombre" => "Alberto"
                "apellidos" => "Berbel-Bonillo"
              ]
              2 => array:2 [
                "nombre" => "Manuel"
                "apellidos" => "P&#233;rez-Guillen"
              ]
              3 => array:2 [
                "nombre" => "Jos&#233; A&#46;"
                "apellidos" => "Montero-Argudo"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0870255119305955"
          "doi" => "10.1016/j.repc.2017.07.023"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119305955?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204920300131?idApp=UINPBA00004E"
      "url" => "/21742049/0000003800000010/v2_202002180803/S2174204920300131/v2_202002180803/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0870255119305748"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2019.01.007"
    "estado" => "S300"
    "fechaPublicacion" => "2019-10-01"
    "aid" => "1455"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Cardiol. 2019;38:739-40"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 174
      "formatos" => array:3 [
        "EPUB" => 27
        "HTML" => 99
        "PDF" => 48
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
      "titulo" => "Papillary fibroelastoma with an atypical location"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "739"
          "paginaFinal" => "740"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Fibroelastoma papilar com localiza&#231;&#227;o at&#237;pica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 754
              "Ancho" => 1300
              "Tamanyo" => 139348
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A-C&#41; Short-axis&#44; apical 4- and 2-chamber transthoracic echocardiographic images&#44; respectively&#44; showing a round mass inside the left ventricle&#44; attached to the papillary muscle &#40;arrow&#41;&#59; &#40;D&#41; three-dimensional echocardiographic short-axis view using the 2-Click Crop function from the apex&#59; &#40;E and F&#41; histopathology&#59; &#40;E&#41; neoform of papillary architecture &#40;Masson&#39;s trichrome&#44; 25&#215;&#41;&#59; &#40;F&#41; papillary axes consisting of collagen&#44; stained green&#44; and lax stroma with endothelial&#47;endocardial coating &#40;Masson&#39;s trichrome&#44; 100&#215;&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Joana Rigueira, Rui Pl&#225;cido, Artur Costa e Silva, Ana G&#46; Almeida, Fausto J&#46; Pinto"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Joana"
              "apellidos" => "Rigueira"
            ]
            1 => array:2 [
              "nombre" => "Rui"
              "apellidos" => "Pl&#225;cido"
            ]
            2 => array:2 [
              "nombre" => "Artur Costa e"
              "apellidos" => "Silva"
            ]
            3 => array:2 [
              "nombre" => "Ana G&#46;"
              "apellidos" => "Almeida"
            ]
            4 => array:2 [
              "nombre" => "Fausto J&#46;"
              "apellidos" => "Pinto"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204920300143"
        "doi" => "10.1016/j.repce.2020.01.011"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204920300143?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119305748?idApp=UINPBA00004E"
    "url" => "/08702551/0000003800000010/v2_202002060715/S0870255119305748/v2_202002060715/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0870255119304809"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2019.02.008"
    "estado" => "S300"
    "fechaPublicacion" => "2019-10-01"
    "aid" => "1422"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "rev"
    "cita" => "Rev Port Cardiol. 2019;38:721-35"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 273
      "formatos" => array:3 [
        "EPUB" => 21
        "HTML" => 180
        "PDF" => 72
      ]
    ]
    "pt" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo de Revis&#227;o</span>"
      "titulo" => "Efeito da empagliflozina para al&#233;m do controlo glic&#233;mico&#58; benef&#237;cio cardiovascular em doentes com DMT2 e doen&#231;a cardiovascular estabelecida"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "721"
          "paginaFinal" => "735"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Effect of empagliflozin beyond glycemic control&#58; Cardiovascular benefit in patients with type 2 diabetes and established cardiovascular disease"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1948
              "Ancho" => 2925
              "Tamanyo" => 263053
            ]
          ]
          "descripcion" => array:1 [
            "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Outcomes</span> prim&#225;rio e secund&#225;rio do estudo EMPA&#8208;REGOUTCOME &#40;adaptado de 30&#41;&#46; &#40;A&#41; <span class="elsevierStyleItalic">Endpoint</span> prim&#225;rio &#40;morte por causa CV&#44; AVC n &#227;o fatal ou EAM n&#227;o fatal&#41;&#44; &#40;B&#41; Morte por causa CV&#44; &#40;C&#41; Morte por qualquer causa&#44; &#40;D&#41; Hospitaliza&#231;&#227;o por IC&#46; HR&#58; <span class="elsevierStyleItalic">Hazard</span> ratio&#59; IC 95&#37;&#58; intervalo de confian&#231;a a 95&#37;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Pedro Monteiro, Carlos Aguiar, Pedro Matos, Jos&#233; Silva&#8208;Nunes, Rita Birne, Patr&#237;cia Branco, Joaquim Calado, Miguel Melo, Jorge Pol&#243;nia"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Monteiro"
            ]
            1 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Aguiar"
            ]
            2 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Matos"
            ]
            3 => array:2 [
              "nombre" => "Jos&#233;"
              "apellidos" => "Silva&#8208;Nunes"
            ]
            4 => array:2 [
              "nombre" => "Rita"
              "apellidos" => "Birne"
            ]
            5 => array:2 [
              "nombre" => "Patr&#237;cia"
              "apellidos" => "Branco"
            ]
            6 => array:2 [
              "nombre" => "Joaquim"
              "apellidos" => "Calado"
            ]
            7 => array:2 [
              "nombre" => "Miguel"
              "apellidos" => "Melo"
            ]
            8 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Pol&#243;nia"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204919302879"
        "doi" => "10.1016/j.repce.2019.02.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919302879?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119304809?idApp=UINPBA00004E"
    "url" => "/08702551/0000003800000010/v2_202002060715/S0870255119304809/v2_202002060715/pt/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Dissected aberrant right subclavian artery with Kommerell diverticulum"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "737&#46;e1"
        "paginaFinal" => "737&#46;e4"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Carlos Dom&#237;nguez-Massa, Alberto Berbel-Bonillo, Manuel P&#233;rez-Guillen, Jos&#233; A&#46; Montero-Argudo"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Carlos"
            "apellidos" => "Dom&#237;nguez-Massa"
            "email" => array:1 [
              0 => "dominguez.massa@gmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Alberto"
            "apellidos" => "Berbel-Bonillo"
          ]
          2 => array:2 [
            "nombre" => "Manuel"
            "apellidos" => "P&#233;rez-Guillen"
          ]
          3 => array:2 [
            "nombre" => "Jos&#233; A&#46;"
            "apellidos" => "Montero-Argudo"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Department of Cardiovascular Surgery&#44; Hospital Universitario y Polit&#233;cnico La Fe&#44; Valencia&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Art&#233;ria subcl&#225;via direita aberrante dissecada com divert&#237;culo de Kommerell"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2080
            "Ancho" => 2987
            "Tamanyo" => 421617
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Complementary preoperative studies&#46; &#40;A&#41; Computed tomography angiography reconstruction showing the supraaortic trunks&#44; including an aberrant right subclavian artery&#59; &#40;B&#41; aortography performed to aid planning of endovascular therapy&#44; which was rejected&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Aberrant right subclavian artery &#40;ARSA&#41; is the most frequent anomaly of the aortic arch&#44; with a reported prevalence ranging between 0&#46;2&#37; and 2&#46;5&#37; of the population&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#8211;3</span></a> and is associated with Kommerell diverticulum &#40;KD&#41; in 60&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;2</span></a> KD is one of the vascular ring group of congenital heart defects and consists of a dilatation of the origin of the subclavian arteries&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> It is usually asymptomatic&#44; but when there are symptoms the most frequent is dysphagia due to compression of the esophagus&#44; followed by asthma due to tracheal compression&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> The diagnosis is made by computed tomography angiography &#40;CTA&#41;&#44; magnetic resonance imaging&#44; or the reference technique&#44; arteriography&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">When KD is complicated by aortic dissection the treatment is surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> However&#44; in asymptomatic cases there are no well-established guidelines for treatment due to its rarity and heterogeneity of presentation&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> In general&#44; surgical intervention is recommended in symptomatic cases&#44; or when the diverticulum is large &#40;in some cases reaching 50 mm&#41;&#44; due to the risk of rupture or embolization&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 54-year-old man arrived at the hospital with symptoms of abrupt chest pain radiating to the neck&#44; not relieved by nitrates&#46; The patient had a history of ARSA diagnosed in another hospital&#44; with dysphagia of unknown duration&#46; Due to the symptoms of acute aortic syndrome&#44; CTA was performed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#44; findings of which were compatible with a dissecting aneurysm of an ARSA compressing the esophagus&#46; The origin of the left subclavian&#44; left carotid and right carotid arteries were not dissected&#44; nor were the ascending thoracic aorta or the descending thoracic aorta&#46; The maximum diameter of the ascending thoracic aorta was 39 mm&#46; Subsequently&#44; aortography &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41; visualized a bulbous origin of the right subclavian artery&#44; diagnostic of KD&#46; Placement of an endoprosthesis at the outlet of the ARSA was ruled out on technical grounds due to the lack of an anchoring zone between the two subclavian arteries&#46; Echocardiography showed a bicuspid aortic valve without flow alterations&#44; aortic root and ascending aorta of normal size&#44; and both ventricles of normal size and contractility&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Once the patient was stable&#44; elective surgery was performed&#44; through a posterolateral thoracotomy in the fourth left intercostal space&#46; Cardiopulmonary bypass &#40;CPB&#41; was established by femoral artery and vein cannulation&#46; The aortic cross-clamp was placed at the mid-distal arch&#44; proximal to the origin of the left subclavian artery&#44; and on the descending thoracic aorta after the distal margin of the aneurysm&#46; Myocardial arrest was not established&#44; which allowed upper body perfusion with a beating heart through patent supra-aortic trunks&#46; CPB was responsible for lower body perfusion&#44; with the arterial cannula positioned in the descending thoracic aorta&#59; there was no need for deep hypothermic circulatory arrest&#46; The aneurysmal segment was resected and replaced by a 28-mm Dacron tube between the origin of the two subclavian arteries and the descending thoracic aorta distal to the origin of the ARSA&#46; Finally&#44; the proximal segment of the ARSA was ligated with a continuous polypropylene suture in two planes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient&#39;s postoperative course was favorable with hemodynamic stability and early extubation&#46; There were no clinical or Doppler signs of critical ischemia in either upper extremity&#46; Postoperative CTA &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41; revealed no sign of complications in the thoracic aorta replacement&#46; Both the right subclavian and the internal thoracic artery were perfused by the vertebral artery through the thoracic inlet&#46; Postoperative echocardiography showed the bicuspid aortic valve to be free of flow alterations&#44; and biventricular function remained good&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Clinically&#44; the patient had dysphonia and dysphagia&#46; At discharge&#44; the dysphagia was resolved but dysphonia persisted&#46; At the six-month postoperative visit&#44; the patient was clinically asymptomatic in cardiorespiratory terms&#44; reporting no chest pain&#44; palpitation or dyspnea&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Preoperative dysphonia is usually due to compression of the recurrent laryngeal nerve&#44; and may be associated with Horner syndrome by compression of sympathetic ganglia and efferent fibers&#46; During surgery&#44; it is important to identify the recurrent nerve as it passes through the aortic arch in order to prevent injury or irritation that may result in dysphonia due to vocal cord paralysis&#46; Once the injury has occurred&#44; vocal rehabilitation may lead to functional recovery&#44; depending on the degree of injury&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The indications for surgical repair in KD have not been established&#44; due to the small number of patients with the condition&#46; Most asymptomatic patients present with rupture&#46; In addition&#44; there are insufficient data to predict rupture based on the size of the diverticulum&#46; However&#44; surgical repair is recommended for symptomatic aneurysms with a diameter of 50 mm or more&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> Our case presented as a complication&#44; and was symptomatic&#44; so surgical repair was recommended&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Some authors recommend surgical repair even in the absence of symptoms due to the risk of aneurysm formation and subsequent dissection&#44; regardless of size at diagnosis&#46; This is related to the embryological origin of this anomaly&#46; In the embryo&#44; the main arterial ducts consist of a right and left dorsal aorta arising from the aortic sac connected to the truncus arteriosus&#46; The six aortic arches give rise to the great arteries&#46; The normal right subclavian artery derives embryologically from the fourth right aortic arch&#44; a portion of the right dorsal aorta and the seventh right intersegmental artery&#46; KD is believed to be a remnant of an isolated residual right dorsal arch&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">KD usually occurs in one of three forms&#46; First&#44; cases with an aberrant left subclavian artery are a consequence of regression in the fourth left aortic arch between the left carotid and the left subclavian arteries&#46; Second&#44; in ARSA&#44; the fourth arch anomaly is the consequence of regression of the right arch between the right subclavian artery and the right and left carotid arteries&#44; and the KD is a remnant of the primitive dorsal right aorta&#46; A third abnormality is a KD in a left aortic arch with a right descending aorta&#44; but this is extremely rare&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Selection of the specific treatment to be adopted is based on patient comorbidities and anatomy&#44; and the surgeon&#39;s preference&#46; Less invasive options are preferred as long as the end result is not compromised&#46; Many patients&#44; however&#44; do not have adequate landing zones for fixation of a stent graft even with adjunctive cervical debranching&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> In the case described&#44; there was no area for stent fixation&#44; so we opted for open surgery instead of an endovascular technique&#46; In addition&#44; no replacement of the ascending thoracic aorta was performed because the ascending aorta measured less than 45 mm with a competent bicuspid aortic valve&#44; although patient follow-up was required&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0060" class="elsevierStylePara elsevierViewall">ARSA is the most frequent anomaly of the aortic arch&#46; In asymptomatic cases there are no well-established guidelines for treatment due to its rarity and heterogeneity of presentation&#44; but when a KD is complicated by aortic dissection the treatment is surgery&#46; Choice of the specific technique used is based on patient comorbidities and anatomy&#44; and the surgeon&#39;s preference&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding sources</span><p id="par0065" class="elsevierStylePara elsevierViewall">No sources of funding&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1299821"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1199262"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1299822"
          "titulo" => "Resumo"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1199261"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case report"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Funding sources"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-05-08"
    "fechaAceptado" => "2017-07-30"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1199262"
          "palabras" => array:3 [
            0 => "Aberrant"
            1 => "Subclavian"
            2 => "Kommerell"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec1199261"
          "palabras" => array:3 [
            0 => "Aberrante"
            1 => "Subcl&#225;via"
            2 => "Kommerell"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aberrant right subclavian artery is the most frequent anomaly of the aortic arch&#44; and in 60&#37; of cases is associated with Kommerell diverticulum&#46; It is usually asymptomatic but may present with dysphagia or asthma due to esophageal and tracheal compression&#46; Indications for surgical repair have not been established&#59; however&#44; when Kommerell diverticulum is complicated by aortic dissection the treatment is surgery&#46; We present the case of a 54-year-old man with thoracic pain due to dissection of an aberrant right subclavian artery associated with Kommerell diverticulum&#46; Elective surgical treatment was performed&#46;</p></span>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A art&#233;ria subcl&#225;via direita aberrante &#233; a anomalia mais frequente do arco a&#243;rtico&#44; em 60&#37; dos casos &#233; associada ao divert&#237;culo de Kommerell&#46; &#201; geralmente assintom&#225;tica ou pode apresentar disfagia ou dispneia&#44; devido &#224; compress&#227;o do es&#243;fago ou traqueia&#46; As indica&#231;&#245;es para a repara&#231;&#227;o cir&#250;rgica n&#227;o foram estabelecidas&#59; no entanto&#44; quando o divert&#237;culo de Kommerell &#233; complicado por dissec&#231;&#227;o a&#243;rtica&#44; o tratamento &#233; cir&#250;rgico&#46; Apresentamos um caso de um homem de 54 anos&#44; com dor tor&#225;cica devido &#224; dissec&#231;&#227;o de uma art&#233;ria subcl&#225;via direita aberrante associada ao divert&#237;culo de Kommerell&#46; &#201; feito um tratamento cir&#250;rgico preferencial&#46;</p></span>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2080
            "Ancho" => 2987
            "Tamanyo" => 421617
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Complementary preoperative studies&#46; &#40;A&#41; Computed tomography angiography reconstruction showing the supraaortic trunks&#44; including an aberrant right subclavian artery&#59; &#40;B&#41; aortography performed to aid planning of endovascular therapy&#44; which was rejected&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1786
            "Ancho" => 1500
            "Tamanyo" => 247060
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Postoperative computed tomography angiography showing the graft implanted in the thoracic aorta&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:7 [
            0 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Arco a&#243;rtico derecho junto con arteria subclavia izquierda aberrante asociada con divert&#237;culo de Kommerell"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Valle-Caballero"
                            1 => "M&#46;&#193;&#46; Guti&#233;rrez-Mart&#237;n"
                            2 => "C&#46; Caparr&#243;s-Escudero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cir Cardiov"
                        "fecha" => "2014"
                        "volumen" => "21"
                        "paginaInicial" => "216"
                        "paginaFinal" => "218"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Kommerell diverticulum and aberrant right subclavian artery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Villaescusa"
                            1 => "J&#46;A&#46; Sarralde"
                            2 => "J&#46;F&#46; Nistal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2016"
                        "volumen" => "69"
                        "paginaInicial" => "696"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical management of aneurysms at the origin of an aberrant right subclavian artery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;W&#46; Verkroost"
                            1 => "R&#46;P&#46; Hamerlijnck"
                            2 => "F&#46;E&#46; Vermeulen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1994"
                        "volumen" => "107"
                        "paginaInicial" => "1469"
                        "paginaFinal" => "1471"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8196390"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hybrid repair of Kommerell diverticulum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Idrees"
                            1 => "S&#46; Keshavamurthy"
                            2 => "S&#46; Subramanian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2013.02.063"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2014"
                        "volumen" => "147"
                        "paginaInicial" => "973"
                        "paginaFinal" => "976"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23535153"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Right aortic arch and an aberrant left subclavian artery arising from a Kommerell diverticulum complicated by acute aortic dissection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;B&#46; Kim"
                            1 => "D&#46;H&#46; Yang"
                            2 => "J&#46;-W&#46; Kang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2012.06.055"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2012"
                        "volumen" => "144"
                        "paginaInicial" => "978"
                        "paginaFinal" => "979"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22835226"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical strategy for Kommerell&#39;s diverticulum&#58; total arch replacement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Tsukui"
                            1 => "S&#46; Aomi"
                            2 => "K&#46; Yamazaki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2013.11.026"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2013"
                        "volumen" => "148"
                        "paginaInicial" => "1423"
                        "paginaFinal" => "1427"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24365271"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contemporany surgical approaches and outcomes in adults with Kommerell diverticulum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46;M&#46; Kim"
                            1 => "R&#46;P&#46; Cambria"
                            2 => "E&#46;M&#46; Isselbacher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2014.05.045"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2014"
                        "volumen" => "98"
                        "paginaInicial" => "1347"
                        "paginaFinal" => "1354"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25134861"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08702551/0000003800000010/v2_202002060715/S0870255119305955/v2_202002060715/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "29263"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Casos Cl&#237;nicos"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003800000010/v2_202002060715/S0870255119305955/v2_202002060715/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119305955?idApp=UINPBA00004E"
]
Partilhar
Informação da revista

Estatísticas

Siga este link para acessar o texto completo do artigo

Case report
Dissected aberrant right subclavian artery with Kommerell diverticulum
Artéria subclávia direita aberrante dissecada com divertículo de Kommerell
Carlos Domínguez-Massa
Autor para correspondência
dominguez.massa@gmail.com

Corresponding author.
, Alberto Berbel-Bonillo, Manuel Pérez-Guillen, José A. Montero-Argudo
Department of Cardiovascular Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Lido
4416
Vezes
que se leu este artigo
1540
Total PDF
2876
Total HTML
Compartilhar estatísticas
 array:25 [
  "pii" => "S0870255119305955"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2017.07.023"
  "estado" => "S300"
  "fechaPublicacion" => "2019-10-01"
  "aid" => "1462"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2019"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "crp"
  "cita" => "Rev Port Cardiol. 2019;38:737&#46;e1-737&#46;e4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 198
    "formatos" => array:3 [
      "EPUB" => 34
      "HTML" => 125
      "PDF" => 39
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S2174204920300131"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2020.01.010"
      "estado" => "S300"
      "fechaPublicacion" => "2019-10-01"
      "aid" => "1462"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "crp"
      "cita" => "Rev Port Cardiol. 2019;38:737&#46;e1-737&#46;e4"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 24
        "formatos" => array:3 [
          "EPUB" => 2
          "HTML" => 18
          "PDF" => 4
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
        "titulo" => "Dissected aberrant right subclavian artery with Kommerell diverticulum"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "737&#46;e1"
            "paginaFinal" => "737&#46;e4"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Art&#233;ria subcl&#225;via direita aberrante dissecada com divert&#237;culo de Kommerell"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figure 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 1786
                "Ancho" => 1500
                "Tamanyo" => 247060
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Postoperative computed tomography angiography showing the graft implanted in the thoracic aorta&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Carlos Dom&#237;nguez-Massa, Alberto Berbel-Bonillo, Manuel P&#233;rez-Guillen, Jos&#233; A&#46; Montero-Argudo"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Carlos"
                "apellidos" => "Dom&#237;nguez-Massa"
              ]
              1 => array:2 [
                "nombre" => "Alberto"
                "apellidos" => "Berbel-Bonillo"
              ]
              2 => array:2 [
                "nombre" => "Manuel"
                "apellidos" => "P&#233;rez-Guillen"
              ]
              3 => array:2 [
                "nombre" => "Jos&#233; A&#46;"
                "apellidos" => "Montero-Argudo"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0870255119305955"
          "doi" => "10.1016/j.repc.2017.07.023"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119305955?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204920300131?idApp=UINPBA00004E"
      "url" => "/21742049/0000003800000010/v2_202002180803/S2174204920300131/v2_202002180803/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0870255119305748"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2019.01.007"
    "estado" => "S300"
    "fechaPublicacion" => "2019-10-01"
    "aid" => "1455"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Cardiol. 2019;38:739-40"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 174
      "formatos" => array:3 [
        "EPUB" => 27
        "HTML" => 99
        "PDF" => 48
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
      "titulo" => "Papillary fibroelastoma with an atypical location"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "739"
          "paginaFinal" => "740"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Fibroelastoma papilar com localiza&#231;&#227;o at&#237;pica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 754
              "Ancho" => 1300
              "Tamanyo" => 139348
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A-C&#41; Short-axis&#44; apical 4- and 2-chamber transthoracic echocardiographic images&#44; respectively&#44; showing a round mass inside the left ventricle&#44; attached to the papillary muscle &#40;arrow&#41;&#59; &#40;D&#41; three-dimensional echocardiographic short-axis view using the 2-Click Crop function from the apex&#59; &#40;E and F&#41; histopathology&#59; &#40;E&#41; neoform of papillary architecture &#40;Masson&#39;s trichrome&#44; 25&#215;&#41;&#59; &#40;F&#41; papillary axes consisting of collagen&#44; stained green&#44; and lax stroma with endothelial&#47;endocardial coating &#40;Masson&#39;s trichrome&#44; 100&#215;&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Joana Rigueira, Rui Pl&#225;cido, Artur Costa e Silva, Ana G&#46; Almeida, Fausto J&#46; Pinto"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Joana"
              "apellidos" => "Rigueira"
            ]
            1 => array:2 [
              "nombre" => "Rui"
              "apellidos" => "Pl&#225;cido"
            ]
            2 => array:2 [
              "nombre" => "Artur Costa e"
              "apellidos" => "Silva"
            ]
            3 => array:2 [
              "nombre" => "Ana G&#46;"
              "apellidos" => "Almeida"
            ]
            4 => array:2 [
              "nombre" => "Fausto J&#46;"
              "apellidos" => "Pinto"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204920300143"
        "doi" => "10.1016/j.repce.2020.01.011"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204920300143?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119305748?idApp=UINPBA00004E"
    "url" => "/08702551/0000003800000010/v2_202002060715/S0870255119305748/v2_202002060715/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0870255119304809"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2019.02.008"
    "estado" => "S300"
    "fechaPublicacion" => "2019-10-01"
    "aid" => "1422"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "rev"
    "cita" => "Rev Port Cardiol. 2019;38:721-35"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 273
      "formatos" => array:3 [
        "EPUB" => 21
        "HTML" => 180
        "PDF" => 72
      ]
    ]
    "pt" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo de Revis&#227;o</span>"
      "titulo" => "Efeito da empagliflozina para al&#233;m do controlo glic&#233;mico&#58; benef&#237;cio cardiovascular em doentes com DMT2 e doen&#231;a cardiovascular estabelecida"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "721"
          "paginaFinal" => "735"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Effect of empagliflozin beyond glycemic control&#58; Cardiovascular benefit in patients with type 2 diabetes and established cardiovascular disease"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1948
              "Ancho" => 2925
              "Tamanyo" => 263053
            ]
          ]
          "descripcion" => array:1 [
            "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Outcomes</span> prim&#225;rio e secund&#225;rio do estudo EMPA&#8208;REGOUTCOME &#40;adaptado de 30&#41;&#46; &#40;A&#41; <span class="elsevierStyleItalic">Endpoint</span> prim&#225;rio &#40;morte por causa CV&#44; AVC n &#227;o fatal ou EAM n&#227;o fatal&#41;&#44; &#40;B&#41; Morte por causa CV&#44; &#40;C&#41; Morte por qualquer causa&#44; &#40;D&#41; Hospitaliza&#231;&#227;o por IC&#46; HR&#58; <span class="elsevierStyleItalic">Hazard</span> ratio&#59; IC 95&#37;&#58; intervalo de confian&#231;a a 95&#37;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Pedro Monteiro, Carlos Aguiar, Pedro Matos, Jos&#233; Silva&#8208;Nunes, Rita Birne, Patr&#237;cia Branco, Joaquim Calado, Miguel Melo, Jorge Pol&#243;nia"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Monteiro"
            ]
            1 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Aguiar"
            ]
            2 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Matos"
            ]
            3 => array:2 [
              "nombre" => "Jos&#233;"
              "apellidos" => "Silva&#8208;Nunes"
            ]
            4 => array:2 [
              "nombre" => "Rita"
              "apellidos" => "Birne"
            ]
            5 => array:2 [
              "nombre" => "Patr&#237;cia"
              "apellidos" => "Branco"
            ]
            6 => array:2 [
              "nombre" => "Joaquim"
              "apellidos" => "Calado"
            ]
            7 => array:2 [
              "nombre" => "Miguel"
              "apellidos" => "Melo"
            ]
            8 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Pol&#243;nia"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204919302879"
        "doi" => "10.1016/j.repce.2019.02.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919302879?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119304809?idApp=UINPBA00004E"
    "url" => "/08702551/0000003800000010/v2_202002060715/S0870255119304809/v2_202002060715/pt/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Dissected aberrant right subclavian artery with Kommerell diverticulum"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "737&#46;e1"
        "paginaFinal" => "737&#46;e4"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Carlos Dom&#237;nguez-Massa, Alberto Berbel-Bonillo, Manuel P&#233;rez-Guillen, Jos&#233; A&#46; Montero-Argudo"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Carlos"
            "apellidos" => "Dom&#237;nguez-Massa"
            "email" => array:1 [
              0 => "dominguez.massa@gmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Alberto"
            "apellidos" => "Berbel-Bonillo"
          ]
          2 => array:2 [
            "nombre" => "Manuel"
            "apellidos" => "P&#233;rez-Guillen"
          ]
          3 => array:2 [
            "nombre" => "Jos&#233; A&#46;"
            "apellidos" => "Montero-Argudo"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Department of Cardiovascular Surgery&#44; Hospital Universitario y Polit&#233;cnico La Fe&#44; Valencia&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Art&#233;ria subcl&#225;via direita aberrante dissecada com divert&#237;culo de Kommerell"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2080
            "Ancho" => 2987
            "Tamanyo" => 421617
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Complementary preoperative studies&#46; &#40;A&#41; Computed tomography angiography reconstruction showing the supraaortic trunks&#44; including an aberrant right subclavian artery&#59; &#40;B&#41; aortography performed to aid planning of endovascular therapy&#44; which was rejected&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Aberrant right subclavian artery &#40;ARSA&#41; is the most frequent anomaly of the aortic arch&#44; with a reported prevalence ranging between 0&#46;2&#37; and 2&#46;5&#37; of the population&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#8211;3</span></a> and is associated with Kommerell diverticulum &#40;KD&#41; in 60&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;2</span></a> KD is one of the vascular ring group of congenital heart defects and consists of a dilatation of the origin of the subclavian arteries&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> It is usually asymptomatic&#44; but when there are symptoms the most frequent is dysphagia due to compression of the esophagus&#44; followed by asthma due to tracheal compression&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> The diagnosis is made by computed tomography angiography &#40;CTA&#41;&#44; magnetic resonance imaging&#44; or the reference technique&#44; arteriography&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">When KD is complicated by aortic dissection the treatment is surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> However&#44; in asymptomatic cases there are no well-established guidelines for treatment due to its rarity and heterogeneity of presentation&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> In general&#44; surgical intervention is recommended in symptomatic cases&#44; or when the diverticulum is large &#40;in some cases reaching 50 mm&#41;&#44; due to the risk of rupture or embolization&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 54-year-old man arrived at the hospital with symptoms of abrupt chest pain radiating to the neck&#44; not relieved by nitrates&#46; The patient had a history of ARSA diagnosed in another hospital&#44; with dysphagia of unknown duration&#46; Due to the symptoms of acute aortic syndrome&#44; CTA was performed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#44; findings of which were compatible with a dissecting aneurysm of an ARSA compressing the esophagus&#46; The origin of the left subclavian&#44; left carotid and right carotid arteries were not dissected&#44; nor were the ascending thoracic aorta or the descending thoracic aorta&#46; The maximum diameter of the ascending thoracic aorta was 39 mm&#46; Subsequently&#44; aortography &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41; visualized a bulbous origin of the right subclavian artery&#44; diagnostic of KD&#46; Placement of an endoprosthesis at the outlet of the ARSA was ruled out on technical grounds due to the lack of an anchoring zone between the two subclavian arteries&#46; Echocardiography showed a bicuspid aortic valve without flow alterations&#44; aortic root and ascending aorta of normal size&#44; and both ventricles of normal size and contractility&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Once the patient was stable&#44; elective surgery was performed&#44; through a posterolateral thoracotomy in the fourth left intercostal space&#46; Cardiopulmonary bypass &#40;CPB&#41; was established by femoral artery and vein cannulation&#46; The aortic cross-clamp was placed at the mid-distal arch&#44; proximal to the origin of the left subclavian artery&#44; and on the descending thoracic aorta after the distal margin of the aneurysm&#46; Myocardial arrest was not established&#44; which allowed upper body perfusion with a beating heart through patent supra-aortic trunks&#46; CPB was responsible for lower body perfusion&#44; with the arterial cannula positioned in the descending thoracic aorta&#59; there was no need for deep hypothermic circulatory arrest&#46; The aneurysmal segment was resected and replaced by a 28-mm Dacron tube between the origin of the two subclavian arteries and the descending thoracic aorta distal to the origin of the ARSA&#46; Finally&#44; the proximal segment of the ARSA was ligated with a continuous polypropylene suture in two planes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient&#39;s postoperative course was favorable with hemodynamic stability and early extubation&#46; There were no clinical or Doppler signs of critical ischemia in either upper extremity&#46; Postoperative CTA &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41; revealed no sign of complications in the thoracic aorta replacement&#46; Both the right subclavian and the internal thoracic artery were perfused by the vertebral artery through the thoracic inlet&#46; Postoperative echocardiography showed the bicuspid aortic valve to be free of flow alterations&#44; and biventricular function remained good&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Clinically&#44; the patient had dysphonia and dysphagia&#46; At discharge&#44; the dysphagia was resolved but dysphonia persisted&#46; At the six-month postoperative visit&#44; the patient was clinically asymptomatic in cardiorespiratory terms&#44; reporting no chest pain&#44; palpitation or dyspnea&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Preoperative dysphonia is usually due to compression of the recurrent laryngeal nerve&#44; and may be associated with Horner syndrome by compression of sympathetic ganglia and efferent fibers&#46; During surgery&#44; it is important to identify the recurrent nerve as it passes through the aortic arch in order to prevent injury or irritation that may result in dysphonia due to vocal cord paralysis&#46; Once the injury has occurred&#44; vocal rehabilitation may lead to functional recovery&#44; depending on the degree of injury&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The indications for surgical repair in KD have not been established&#44; due to the small number of patients with the condition&#46; Most asymptomatic patients present with rupture&#46; In addition&#44; there are insufficient data to predict rupture based on the size of the diverticulum&#46; However&#44; surgical repair is recommended for symptomatic aneurysms with a diameter of 50 mm or more&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> Our case presented as a complication&#44; and was symptomatic&#44; so surgical repair was recommended&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Some authors recommend surgical repair even in the absence of symptoms due to the risk of aneurysm formation and subsequent dissection&#44; regardless of size at diagnosis&#46; This is related to the embryological origin of this anomaly&#46; In the embryo&#44; the main arterial ducts consist of a right and left dorsal aorta arising from the aortic sac connected to the truncus arteriosus&#46; The six aortic arches give rise to the great arteries&#46; The normal right subclavian artery derives embryologically from the fourth right aortic arch&#44; a portion of the right dorsal aorta and the seventh right intersegmental artery&#46; KD is believed to be a remnant of an isolated residual right dorsal arch&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">KD usually occurs in one of three forms&#46; First&#44; cases with an aberrant left subclavian artery are a consequence of regression in the fourth left aortic arch between the left carotid and the left subclavian arteries&#46; Second&#44; in ARSA&#44; the fourth arch anomaly is the consequence of regression of the right arch between the right subclavian artery and the right and left carotid arteries&#44; and the KD is a remnant of the primitive dorsal right aorta&#46; A third abnormality is a KD in a left aortic arch with a right descending aorta&#44; but this is extremely rare&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Selection of the specific treatment to be adopted is based on patient comorbidities and anatomy&#44; and the surgeon&#39;s preference&#46; Less invasive options are preferred as long as the end result is not compromised&#46; Many patients&#44; however&#44; do not have adequate landing zones for fixation of a stent graft even with adjunctive cervical debranching&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> In the case described&#44; there was no area for stent fixation&#44; so we opted for open surgery instead of an endovascular technique&#46; In addition&#44; no replacement of the ascending thoracic aorta was performed because the ascending aorta measured less than 45 mm with a competent bicuspid aortic valve&#44; although patient follow-up was required&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0060" class="elsevierStylePara elsevierViewall">ARSA is the most frequent anomaly of the aortic arch&#46; In asymptomatic cases there are no well-established guidelines for treatment due to its rarity and heterogeneity of presentation&#44; but when a KD is complicated by aortic dissection the treatment is surgery&#46; Choice of the specific technique used is based on patient comorbidities and anatomy&#44; and the surgeon&#39;s preference&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding sources</span><p id="par0065" class="elsevierStylePara elsevierViewall">No sources of funding&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1299821"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1199262"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1299822"
          "titulo" => "Resumo"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1199261"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case report"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Funding sources"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-05-08"
    "fechaAceptado" => "2017-07-30"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1199262"
          "palabras" => array:3 [
            0 => "Aberrant"
            1 => "Subclavian"
            2 => "Kommerell"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec1199261"
          "palabras" => array:3 [
            0 => "Aberrante"
            1 => "Subcl&#225;via"
            2 => "Kommerell"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aberrant right subclavian artery is the most frequent anomaly of the aortic arch&#44; and in 60&#37; of cases is associated with Kommerell diverticulum&#46; It is usually asymptomatic but may present with dysphagia or asthma due to esophageal and tracheal compression&#46; Indications for surgical repair have not been established&#59; however&#44; when Kommerell diverticulum is complicated by aortic dissection the treatment is surgery&#46; We present the case of a 54-year-old man with thoracic pain due to dissection of an aberrant right subclavian artery associated with Kommerell diverticulum&#46; Elective surgical treatment was performed&#46;</p></span>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A art&#233;ria subcl&#225;via direita aberrante &#233; a anomalia mais frequente do arco a&#243;rtico&#44; em 60&#37; dos casos &#233; associada ao divert&#237;culo de Kommerell&#46; &#201; geralmente assintom&#225;tica ou pode apresentar disfagia ou dispneia&#44; devido &#224; compress&#227;o do es&#243;fago ou traqueia&#46; As indica&#231;&#245;es para a repara&#231;&#227;o cir&#250;rgica n&#227;o foram estabelecidas&#59; no entanto&#44; quando o divert&#237;culo de Kommerell &#233; complicado por dissec&#231;&#227;o a&#243;rtica&#44; o tratamento &#233; cir&#250;rgico&#46; Apresentamos um caso de um homem de 54 anos&#44; com dor tor&#225;cica devido &#224; dissec&#231;&#227;o de uma art&#233;ria subcl&#225;via direita aberrante associada ao divert&#237;culo de Kommerell&#46; &#201; feito um tratamento cir&#250;rgico preferencial&#46;</p></span>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2080
            "Ancho" => 2987
            "Tamanyo" => 421617
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Complementary preoperative studies&#46; &#40;A&#41; Computed tomography angiography reconstruction showing the supraaortic trunks&#44; including an aberrant right subclavian artery&#59; &#40;B&#41; aortography performed to aid planning of endovascular therapy&#44; which was rejected&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1786
            "Ancho" => 1500
            "Tamanyo" => 247060
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Postoperative computed tomography angiography showing the graft implanted in the thoracic aorta&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:7 [
            0 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Arco a&#243;rtico derecho junto con arteria subclavia izquierda aberrante asociada con divert&#237;culo de Kommerell"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Valle-Caballero"
                            1 => "M&#46;&#193;&#46; Guti&#233;rrez-Mart&#237;n"
                            2 => "C&#46; Caparr&#243;s-Escudero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cir Cardiov"
                        "fecha" => "2014"
                        "volumen" => "21"
                        "paginaInicial" => "216"
                        "paginaFinal" => "218"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Kommerell diverticulum and aberrant right subclavian artery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Villaescusa"
                            1 => "J&#46;A&#46; Sarralde"
                            2 => "J&#46;F&#46; Nistal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2016"
                        "volumen" => "69"
                        "paginaInicial" => "696"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical management of aneurysms at the origin of an aberrant right subclavian artery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;W&#46; Verkroost"
                            1 => "R&#46;P&#46; Hamerlijnck"
                            2 => "F&#46;E&#46; Vermeulen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1994"
                        "volumen" => "107"
                        "paginaInicial" => "1469"
                        "paginaFinal" => "1471"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8196390"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hybrid repair of Kommerell diverticulum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Idrees"
                            1 => "S&#46; Keshavamurthy"
                            2 => "S&#46; Subramanian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2013.02.063"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2014"
                        "volumen" => "147"
                        "paginaInicial" => "973"
                        "paginaFinal" => "976"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23535153"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Right aortic arch and an aberrant left subclavian artery arising from a Kommerell diverticulum complicated by acute aortic dissection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;B&#46; Kim"
                            1 => "D&#46;H&#46; Yang"
                            2 => "J&#46;-W&#46; Kang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2012.06.055"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2012"
                        "volumen" => "144"
                        "paginaInicial" => "978"
                        "paginaFinal" => "979"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22835226"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical strategy for Kommerell&#39;s diverticulum&#58; total arch replacement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Tsukui"
                            1 => "S&#46; Aomi"
                            2 => "K&#46; Yamazaki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2013.11.026"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2013"
                        "volumen" => "148"
                        "paginaInicial" => "1423"
                        "paginaFinal" => "1427"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24365271"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contemporany surgical approaches and outcomes in adults with Kommerell diverticulum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46;M&#46; Kim"
                            1 => "R&#46;P&#46; Cambria"
                            2 => "E&#46;M&#46; Isselbacher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2014.05.045"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2014"
                        "volumen" => "98"
                        "paginaInicial" => "1347"
                        "paginaFinal" => "1354"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25134861"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08702551/0000003800000010/v2_202002060715/S0870255119305955/v2_202002060715/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "29263"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Casos Cl&#237;nicos"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003800000010/v2_202002060715/S0870255119305955/v2_202002060715/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119305955?idApp=UINPBA00004E"
]
Informação do artigo
ISSN: 08702551
Idioma original: Inglês
Dados atualizados diariamente
Ano/Mês Html Pdf Total
2024 Novembro 18 8 26
2024 Outubro 77 36 113
2024 Setembro 93 34 127
2024 Agosto 110 27 137
2024 Julho 89 37 126
2024 Junho 49 28 77
2024 Maio 64 22 86
2024 Abril 53 31 84
2024 Maro 55 27 82
2024 Fevereiro 32 15 47
2024 Janeiro 40 27 67
2023 Dezembro 28 24 52
2023 Novembro 46 34 80
2023 Outubro 43 21 64
2023 Setembro 28 18 46
2023 Agosto 32 21 53
2023 Julho 48 15 63
2023 Junho 38 21 59
2023 Maio 50 31 81
2023 Abril 29 2 31
2023 Maro 42 21 63
2023 Fevereiro 31 17 48
2023 Janeiro 27 19 46
2022 Dezembro 35 21 56
2022 Novembro 43 38 81
2022 Outubro 52 25 77
2022 Setembro 33 38 71
2022 Agosto 45 40 85
2022 Julho 38 40 78
2022 Junho 28 26 54
2022 Maio 29 49 78
2022 Abril 39 28 67
2022 Maro 41 36 77
2022 Fevereiro 34 35 69
2022 Janeiro 43 46 89
2021 Dezembro 34 35 69
2021 Novembro 59 46 105
2021 Outubro 84 36 120
2021 Setembro 44 29 73
2021 Agosto 55 28 83
2021 Julho 35 28 63
2021 Junho 26 23 49
2021 Maio 42 35 77
2021 Abril 90 51 141
2021 Maro 86 26 112
2021 Fevereiro 48 17 65
2021 Janeiro 61 16 77
2020 Dezembro 58 12 70
2020 Novembro 41 23 64
2020 Outubro 29 18 47
2020 Setembro 58 14 72
2020 Agosto 70 13 83
2020 Julho 67 11 78
2020 Junho 40 15 55
2020 Maio 26 11 37
2020 Abril 45 13 58
2020 Maro 44 24 68
2020 Fevereiro 120 53 173
2020 Janeiro 32 5 37
Mostrar tudo

Siga este link para acessar o texto completo do artigo

Idiomas
Revista Portuguesa de Cardiologia
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Ao assinalar que é «Profissional de Saúde», declara conhecer e aceitar que a responsável pelo tratamento dos dados pessoais dos utilizadores da página de internet da Revista Portuguesa de Cardiologia (RPC), é esta entidade, com sede no Campo Grande, n.º 28, 13.º, 1700-093 Lisboa, com os telefones 217 970 685 e 217 817 630, fax 217 931 095 e com o endereço de correio eletrónico revista@spc.pt. Declaro para todos os fins, que assumo inteira responsabilidade pela veracidade e exatidão da afirmação aqui fornecida.