Surgical treatment for right aortic arch with Kommerell’s diverticulum

Abstract

Kommerell's diverticulum causes compression of the esophagus between the aberrant origin of the left subclavian artery and ascending aorta, leading to dysphagia or dyspnea. We describe 3 cases of successful surgical treatment of right aortic arch with Kommerell's diverticulum and aberrant origin of the left subclavian artery, using a right anterolateral partial sternotomy. This allows both resection of the Kommerell's diverticulum as well as reconstruction of the aberrant origin of the left subclavian artery anatomically.

Surgical treatment of Kommerell's diverticulum

“…15 The main stage in the surgical treatment of KD in adults is a descending aorta replacement with the reconstruction of the aberrant subclavian artery and complete replacement of the aortic arch. 8,[16][17][18] Endovascular treatment of pathology of ARSA is also effective if patients are carefully selected. So, a 57-year-old woman with stent (CT) was performed 5 years after the procedure, demonstrating a patent stent.…”

“…According to current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch, an aneurysmatic subclavian artery (more 3 cm) and/or KD (more 5.5 cm) should be considered for repair 15 . The main stage in the surgical treatment of KD in adults is a descending aorta replacement with the reconstruction of the aberrant subclavian artery and complete replacement of the aortic arch 8,16–18 …”

Right-sided aortic arch with Kommerell′s aneurysm

“…A NG tube was inserted to help the surgeon to identify the esophagus. Lung isolation for this procedure using double lumen tubes have been debated in literature, [12,13] but in view of the degree of tracheal deviation we opted to use a single lumen tube with a bronchial blocker.…”