Open Thoracic Aortic Repair for Dysphagia in Patients with Kommerell's Diverticulum and Right-Sided Aortic Arch with Aberrant Left Subclavian Artery

Abstract

Kommerell's diverticulum of an aberrant left subclavian artery associated with a right-sided aortic arch is a rare congenital aortic anomaly. This communication reports two cases of this congenital anomaly leading to severe dysphagia. Both cases were successfully repaired with a staged open approach rather than an endovascular approach, which would not have addressed the presenting symptom of dysphagia.

Hybrid Procedure for a Kommerell^|^apos;s Diverticulum in a Right-Sided Aortic Arch

“…One concern for the surgical approach to an aneurysmal Kommerell's diverticulum is the anatomical variation of the aortic arch vessels, especially the ALSCA, which is derived from the diverticulum and runs behind the esophagus. 5,7) A Kommerell's diverticulum has been resected successfully via thoracotomy 8,9) ; however, in the present case, a right thoracotomy would have been required to approach the distal site of the diverticulum, while manipulation of the ALSCA would have been needed in the left thoracic cavity since the diverticulum protruded over spines from the right to the left side. The thoracotomy would have been dangerous as the respiratory function of the patient was deteriorated due to chronic obstructive pulmonary disease.…”

Arteria Subclavia Derecha Retroesofágica: Reporte de Caso

“…De entre todas estas anomalías congénitas el arco aórtico con ASDR también conocida como «arteria lusoria», es la más frecuente, encontrándose presente en un 0,5-2 % de la población. Esta anomalía es el resultado de la obliteración del cuarto AO entre la ACCD y la ASDR (Duque et al; Leite et al;Simón-Yarza et al, 2011). En esta variante anatómica nacen del cayado aórtico, consecutivamente, las ACCD, arteria carótida común izquierda (ACCI), arteria subclavia izquierda (ASI) y subclavia derecha.…”

“…En caso de disfagia, su manejo clínico depende de la severidad de los síntomas. En situaciones de disfagia leve o moderada un tratamiento conservador modificando la dieta y administrando fármacos procinéticos puede ser suficiente (Reece et al, 2010). El tratamiento quirúrgico está reservado para aquellos casos en que la disfagia sea severa o el riesgo de rotura del aneurisma sea elevado y consiste, habitualmente, en la resección de la arteria subclavia aberrante mediante esternotomía media o toracotomía y su anastomosis a la arteria carótida común ipsilateral (Myers et al, 2010;Simón-Yarza et al).…”

Right-sided aortic arch with aberrant left subclavian artery and Kommerell diverticulum

“…Aberrant left subclavian artery is an uncommon congenital arch anomaly with 0.5% to 1.8% prevalence 1 . Right-sided aortic arch, occurring in approximately 0.1% of the population, results from persistence of the right fourth aortic arch and involution of the left fourth arch 2 .…”