Aortic arch reconstruction using a Kommerell diverticulum for hypoplastic left heart syndrome with a right aortic arch

Abstract

We describe right aortic arch reconstruction using a Kommerell diverticulum in a Norwood modification for hypoplastic left heart syndrome (HLHS) with a hypoplastic right aortic arch, a Kommerell diverticulum, and a right-sided descending aorta. This method removes the retroesophageal component of the aorta and ensures an unobstructed aortic pathway and a sufficient aortopulmonary space with the advantage of growth potential. DISCUSSION Right aortic arch hypoplasia in a variant of HLHS is extremely rare. Few reports have described the operative technique of the Norwood procedure in this patient From the

Norwood modification for hypoplastic left heart and right aortic arch

“…Interestingly, review of literature on HLHS with RAA revealed common association with unusual origin of either the innominate or left subclavian artery. 2 , 3 , 4 , 5 In our case, it arose from the distal pulmonary artery. To potentially avoid any steal of pulmonary blood flow, we chose to ligate it.…”

“…Only one successful case of Norwood modification for RAA with right descending thoracic aorta has been described using a large diameter Kommerell diverticulum. 5 In this case, following excision of the ductus, the large Kommerell diverticulum was mobilized to the right side of the trachea and anastomosed to the neoaortic root. 5 However, the technique can only be used when there is an unusually large diverticulum.…”

“… 5 In this case, following excision of the ductus, the large Kommerell diverticulum was mobilized to the right side of the trachea and anastomosed to the neoaortic root. 5 However, the technique can only be used when there is an unusually large diverticulum. Our modification of leftward transposition of the ascending aorta is a more reproducible technique.…”

“…Norwood modification for RAA with left descending thoracic aorta has been successfully described with the reconstructed aortic arch lying either in front or behind the trachea. 2 , 3 , 4 , 5 However, a RAA with right descending thoracic aorta poses more challenges for Norwood type reconstruction. Only one successful case of Norwood modification for RAA with right descending thoracic aorta has been described using a large diameter Kommerell diverticulum.…”

Norwood Procedure in a Patient With Hypoplastic Left Heart Syndrome, Right Aortic Arch, and Right Descending Aorta

“…The repair was performed by transecting the duct and resecting the ductal tissue, bringing the Kommerell diverticulum in front of the trachea, and performing a double-barrel type of Damus/Kaye/Stansel anastomosis, anastomosing, to the roof of this neoaorta, the distally transected AAo. 7 Our case presented with the hypoplastic AAo, hypoplastic RAA, coarctation, and right descending Ao. In this variant, the location of the PA, to the left of the AAo but with the aortic arch running toward the opposite side, precludes the repair most commonly performed in patients with left aortic arch (and in at least 2 of those with an RAA and circumflex, retroesophageal aorta, described in previous reports), that includes the more typical amalgamation of the proximal portion of the transected PA with the AAo, as originally described by Norwood.…”