Double Aortic Arch With Kommerell Diverticulum

Backer, Carl L.; Bharadwaj, Sandeep; Eltayeb, Osama; Forbess, Joseph M.; Popescu, Andrada; Mongé, Michael C.

doi:10.1016/j.athoracsur.2019.01.062

Cited by 23 publications

(11 citation statements)

References 14 publications

(21 reference statements)

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“…Resection of the KD during vascular ring relief has been addressed by several studies, including most notably, Backer et al 15 In those with an RAA LDA ALSCA, Becker suggested a ratio of ≥1.5 for the diameters of the KD versus the arising aberrant left subclavian artery, as a guide for KD resection and ALSCA reimplantation. A KD or posterior 4th aortic arch segment is also present in an RAA LDA MIB and a DAA with an atretic post LAA segment 16 ; however, these anatomical variants are not associated with an ALSCA. Additionally, DAA without atretic segments, following division, had a similar approach to the remnant post 4th LAA segment; that is, resection or not.…”

Section: Discussionmentioning

confidence: 99%

Isolated vascular rings in the era of high prenatal detection rates: Demographics, diagnosis, risk factors, and outcome

et al. 2021

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Objective: We reviewed our center's isolated vascular ring data. Methods: Inclusion criteria were patients born in Nevada between June 2015 and July 2020 with situs solitus, levocardia, atrioventricular and ventriculoarterial concordance, and no significant intracardiac malformations. Results: We identified 95 patients. Of the 95, 56 (59%) were female (p = .033). For the study period, there were approximately 180,000 live births, for a prevalence of 5.3 isolated vascular rings per 10,000 live births. Of the 95, 78 (82%) were prenatally diagnosed. Of the 95, 63 (66%) were products of high-risk pregnancies (p = .0001). Additionally, we found advanced maternal age was an isolated vascular ring risk factor (relative risk ratio, 2.7; 95% confidence interval, 1.8, 4.1; p < .00001). Conclusions: Isolated vascular rings are relatively common cardiovascular malformations and more common in females. High prenatal detection rates are achievable. Further, the majority with isolated vascular rings are products of high-risk pregnancies, and advanced maternal age is a statistically significant occurrence risk factor.

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Section: Discussionmentioning

confidence: 99%

Isolated vascular rings in the era of high prenatal detection rates: Demographics, diagnosis, risk factors, and outcome

et al. 2021

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“…Following repair of double aortic arch where the smaller left arch is divided [ Figure 3A-C], the preserved retroesophageal arch segment will resemble a circumflex arch [35] . A completely atretic segment [ Figure 3D] can be present between the left common carotid and subclavian arteries in the setting of a double aortic arch with a dominant right [36][37][38] . They are strictly speaking, by morphology criteria, a double aortic arch, but functionally resemble a circumflex arch with a high retroesophageal segment above the tracheal carina [36] .…”

Section: Vascular Ring Variants Resembling Circumflex Aortamentioning

confidence: 99%

“…A completely atretic segment [ Figure 3D] can be present between the left common carotid and subclavian arteries in the setting of a double aortic arch with a dominant right [36][37][38] . They are strictly speaking, by morphology criteria, a double aortic arch, but functionally resemble a circumflex arch with a high retroesophageal segment above the tracheal carina [36] . In true circumflex arch, there is no connecting segment between these two neck vessels [ Figure 3A].…”

Section: Vascular Ring Variants Resembling Circumflex Aortamentioning

confidence: 99%

Congenital arch malformation: a review of morphology and surgical management of circumflex aortic arch

Bader¹,

Knight²,

Danton³

et al. 2020

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“…A Kommerell's diverticulum was first described by the radiologist Burckhard Kommerell in 1936 in a patient with dysphagia due to esophageal compression that was related to an aneurysmatic onset of an aberrant right subclavian artery from a left-sided aortic arch [2,3]. Currently, the definition also includes an aneurysmatic origin of an aberrant left subclavian artery from a right-sided aortic arch, and it may also be present in patients with a double aortic arch [4]. From surgical and radiology series, it has been estimated that the prevalence of a left-sided aortic arch with an aberrant right subclavian artery ranges between 0.7-2.0% and between 0.04-0.4% for a right-sided aortic arch with an aberrant left subclavian artery [3,5].…”

Section: Introduction: From Embryology To Clinical Presentationmentioning

confidence: 99%

The Clinical Spectrum of Kommerell’s Diverticulum in Adults with a Right-Sided Aortic Arch: A Case Series and Literature Overview

Rosendael

Stöger

Kiès

et al. 2021

JCDD

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Background: Kommerell’s diverticulum is a rare vascular anomaly characterized as an outpouch at the onset of an aberrant subclavian artery. In the variant of a right-sided aortic arch, the trachea and esophagus are enclosed dorsally by the arch. In the configuration of an aberrant left subclavian artery, a Kommerell’s diverticulum and persisting ductus arteriosus or ductal ligament enclose the lateral side, forming a vascular ring which may result in (symptomatic) esophageal or tracheal compression. Spontaneous rupture of an aneurysmatic Kommerell’s diverticulum has also been reported. Due to the rarity of this condition and underreporting in the literature, the clinical implications of a Kommerell’s diverticulum are not well defined. Case summary: We describe seven consecutive adult patients with a right-sided aortic arch and an aberrant course of the left subclavian artery (arteria lusoria), and a Kommerell’s diverticulum, diagnosed in our tertiary hospital. One patient had severe symptoms related to the Kommerell’s diverticulum and underwent surgical repair. In total, two of the patients experienced mild non-limiting dyspnea complaints and in four patients the Kommerell’s diverticulum was incidentally documented on a computed tomography (CT) scan acquired for a different indication. The size of the Kommerell’s diverticulum ranged from 19 × 21 mm to 30 × 29 mm. In the six patients that did not undergo surgery, a strategy of periodic follow-up with structural imaging was pursued. No significant growth of the Kommerell’s diverticulum was observed and none of the patients experienced an acute aortic syndrome to date. Discussion: Kommerell’s diverticulum in the setting of a right-sided aortic arch with an aberrant left subclavian artery is frequently associated with tracheal and esophageal compression and this may result in a varying range of symptoms. Guidelines on management of Kommerell’s diverticulum are currently lacking. This case series and literature overview suggests that serial follow-up is warranted in adult patients with a Kommerell’s diverticulum with small dimensions and no symptoms, however, that surgical intervention should be considered when patients become symptomatic or when the diameter exceeds 30 mm in the absence of symptoms.

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Double Aortic Arch With Kommerell Diverticulum

Cited by 23 publications

References 14 publications

Isolated vascular rings in the era of high prenatal detection rates: Demographics, diagnosis, risk factors, and outcome

Isolated vascular rings in the era of high prenatal detection rates: Demographics, diagnosis, risk factors, and outcome

Congenital arch malformation: a review of morphology and surgical management of circumflex aortic arch

The Clinical Spectrum of Kommerell’s Diverticulum in Adults with a Right-Sided Aortic Arch: A Case Series and Literature Overview

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