Department of Cardiothoracic Surgery, Center for Congenital Heart Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Electronic address:
Published: January 2020
AI Article Synopsis
Article Abstract
A right aortic arch vascular ring consists of an anomalous aortic arch course with a ligamentum arteriosum and an aberrant left subclavian artery arising from a Kommerell diverticulum. Division of the ligamentum arteriosum is required for the relief of symptoms in these patients. However, to prevent recurrent symptoms, resection of the Kommerell diverticulum and reimplantation of the subclavian artery to the left carotid artery is advocated. Here we describe our standardized surgical approach to this pathology.
Kommerell's diverticulum with an aberrant subclavian artery is a rare congenital aortic arch anomaly. Therefore surgical indication and strategy are not well established. A 43-year-old man was referred to our hospital with a chief complaint of chest and back pain.
Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA. Electronic address:
Introduction: It is unclear if certain anatomic characteristics in patients with a right aortic arch with aberrant left subclavian artery (RAA ALSCA) are associated with undergoing surgical repair.
Methods: This was a single-center retrospective study of patients with RAA ALSCA and computed tomography or cardiovascular magnetic resonance from July 2013-September 2023. The size of the proximal ALSCA or diverticulum of Kommerell (DoK), thoracic inlet index, angle of the proximal ALSCA/DoK from the aortic arch, the position of descending aorta, location of the DoK, and tracheal size were compared between patients who did or did not undergo surgery.
A Kommerell's diverticulum (KD) is a saccular aneurysmal outpouching at the origin of an aberrant subclavian artery. Due to a lack of data in the literature, there are no standardized guidelines for management of KD, and the diverse presentation of associated aberrant anatomy complicates evaluating the best modality of treatment. We present a 74-year-old woman who had a uniquely aberrant aortic arch with an aberrant retroesophageal right subclavian artery associated with a KD and a saccular aneurysm off the left subclavian artery who was treated via a hybrid approach, demonstrating the feasibility of this treatment modality in a patient with unique aberrant arch anatomy.
