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Tanda E, Deiana G, Spanu F, Genadiev G, Moro M, Arzedi R, Ruiu G, Camparini S. Images in Vascular Medicine: Hybrid surgical repair of a giant Kommerell diverticulum in a bovine aortic arch. Vasc Med 2025:1358863X251333622. [PMID: 40391613 DOI: 10.1177/1358863x251333622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2025]
Affiliation(s)
- Elisabetta Tanda
- Cardiovascular Department, Unit of Vascular Surgery, San Michele Hospital, ARNAS "G. Brotzu," Cagliari, Sardinia, Italy
| | - Giuseppe Deiana
- Cardiovascular Department, Unit of Vascular Surgery, San Michele Hospital, ARNAS "G. Brotzu," Cagliari, Sardinia, Italy
| | - Francesco Spanu
- Cardiovascular Department, Unit of Vascular Surgery, San Michele Hospital, ARNAS "G. Brotzu," Cagliari, Sardinia, Italy
| | - Genadi Genadiev
- Cardiovascular Department, Unit of Vascular Surgery, San Michele Hospital, ARNAS "G. Brotzu," Cagliari, Sardinia, Italy
| | - Mario Moro
- Cardiovascular Department, Unit of Vascular Surgery, San Michele Hospital, ARNAS "G. Brotzu," Cagliari, Sardinia, Italy
| | - Roberta Arzedi
- Cardiovascular Department, Unit of Vascular Surgery, San Michele Hospital, ARNAS "G. Brotzu," Cagliari, Sardinia, Italy
| | - Giovanni Ruiu
- Cardiovascular Department, Unit of Vascular Surgery, San Michele Hospital, ARNAS "G. Brotzu," Cagliari, Sardinia, Italy
| | - Stefano Camparini
- Cardiovascular Department, Unit of Vascular Surgery, San Michele Hospital, ARNAS "G. Brotzu," Cagliari, Sardinia, Italy
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Ahmad N, Huang L, Chen X, Huang Y, Li J, Xie Z. Outcomes of surgical management for Kommerell's diverticulum associated with type B aortic dissection. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2025; 40:ivaf015. [PMID: 39906973 PMCID: PMC11997754 DOI: 10.1093/icvts/ivaf015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Revised: 12/27/2024] [Accepted: 01/31/2025] [Indexed: 02/06/2025]
Abstract
OBJECTIVES Kommerell's diverticulum presents a distinctive challenge in clinical management due to its rarity and diverse clinical manifestations, particularly when concurrent with type B aortic dissection. However, a consensus on the optimal treatment strategy has yet to be established. This study presents our experience with an open surgical approach to treating Kommerell's diverticulum associated with type B aortic dissection. METHODS This retrospective study evaluated 10 patients who underwent surgical repair for Kommerell's diverticulum with concurrent type B aortic dissection. Through median sternotomy, under cardiopulmonary bypass and deep hypothermic circulatory arrest + retrograde cerebral perfusion, a frozen elephant trunk stent graft was deployed in the descending thoracic aorta to address the type B aortic dissection and Kommerell's diverticulum. Aberrant subclavian arteries were reconstructed by bypassing the distal portion into the native ascending aorta or carotid artery, accompanied by proximal ligation of the aberrant artery. RESULTS The median age of the patient was 49 years (interquartile range: 42.2-58.5). There were no in-hospital or 30-day postoperative deaths. All patients were discharged with a median hospital stay of 8.5 days (interquartile range: 7.75-10.5). No cases of stroke or spinal cord ischaemia were observed. Follow-up was completed for all patients, with a mean duration of 27.4 (standard deviation: 15.3) months, during which no adverse events occurred. CONCLUSIONS This surgical approach for managing Kommerell's diverticulum with type B aortic dissection offers a safe and effective option, yielding favourable short-term outcomes. It may provide a durable alternative to traditional surgical methods and overcome limitations associated with endovascular surgeries.
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Affiliation(s)
- Nouman Ahmad
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lingjin Huang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuliang Chen
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yingjie Huang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiawei Li
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhongshang Xie
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Sakakibara S, Shimamura K, Shijo T, Maeda K, Yamashita K, Matsumoto R, Yoshioka D, Taira M, Miyagawa S. Midterm Morphological Change of Kommerell's Diverticulum after Hybrid Thoracic Endovascular Aortic Repair. Ann Vasc Surg 2025; 110:17-22. [PMID: 39427982 DOI: 10.1016/j.avsg.2024.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 09/30/2024] [Accepted: 10/02/2024] [Indexed: 10/22/2024]
Abstract
BACKGROUND Kommerell's diverticulum (KD) is associated with a high incidence of right-sided aortic arch (RAA). Hybrid thoracic endovascular aortic repair (TEVAR) is an effective and less invasive alternative to open repair. However, the long-term results regarding KD diameter regression or symptom improvement remain inadequately described. METHODS Nine patients underwent TEVAR for KD associated with RAA between January 2016 and September 2023 at our university hospital and affiliated institutions. A hybrid procedure was performed to exclude KD by blocking the proximal blood flow with TEVAR and distal blood flow with embolization of the aberrant subclavian artery. Simultaneously, extra-anatomical bypass surgery was performed to revascularize the covered supraarch vessels. RESULTS The patients' mean age was 65.2 years, and 6 patients were men. Two patients presented with dysphagia, whereas the rest were asymptomatic. The mean diameter and distance to the opposite aortic wall (OAW) of KD were 32.1 mm and 56.2 mm, respectively. For revascularization of the covered supraarch vessels, 6 and 2 patients underwent total debranching with sternotomy and extra-thoracic bypass (bilateral common carotid artery-axial artery bypass), respectively. The 30-day and in-hospital mortality rates were 0%, with no instances of cerebral infarction or spinal cord ischemia. The mean follow-up period was 3.2 years. The survival and avoidance rates of aortic events were 100% at 1 and 3 years. Follow-up computed tomography scans showed no endoleaks; however, 1 (11.1%) type 2 endoleak from the aberrant left subclavian artery occurred 1 week postoperatively, necessitating additional coiling. Seven patients were followed up for more than 1 year, with 5 experiencing reductions of more than 3 mm in KD diameter, distance to the OAW, or both. CONCLUSIONS Although further follow-up and investigations are needed, TEVAR may be a safe and effective surgical treatment for KD associated with RAA.
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Affiliation(s)
- Satoshi Sakakibara
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryota Matsumoto
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Taira
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Fabela-Hardy CA, Moreno-Ruiz LA, Necoechea-Osuna Y, Conde-García CC. Kommerell's diverticulum as an unusual cause of back pain and differential diagnosis for mediastinal enlargement: images in cardiology. Eur Heart J Case Rep 2024; 8:ytae639. [PMID: 39687541 PMCID: PMC11647580 DOI: 10.1093/ehjcr/ytae639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 11/06/2024] [Accepted: 11/22/2024] [Indexed: 12/18/2024]
Affiliation(s)
- Carlo Alberto Fabela-Hardy
- Division of Cardiology, Hospital de Cardiología Centro Médico Nacional Siglo XXI, IMSS. Cuauhtémoc Av. 330, 06720 Mexico City, Mexico
| | - Luis Antonio Moreno-Ruiz
- Division of Cardiology, Hospital de Cardiología Centro Médico Nacional Siglo XXI, IMSS. Cuauhtémoc Av. 330, 06720 Mexico City, Mexico
| | - Yatzil Necoechea-Osuna
- Division of Cardiology, Hospital de Cardiología Centro Médico Nacional Siglo XXI, IMSS. Cuauhtémoc Av. 330, 06720 Mexico City, Mexico
| | - Carla Camila Conde-García
- Cardiovascular Intensive Care Unit, Hospital de Beneficencia Española. Calle 19 Nte. 1001, 72090 Puebla, Mexico
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Baz RO, Refi D, Scheau C, Axelerad A, Baz RA, Niscoveanu C. CT Angiography for Aortic Arch Anomalies: Prevalence, Diagnostic Efficacy, and Illustrative Findings. Diagnostics (Basel) 2024; 14:1851. [PMID: 39272636 PMCID: PMC11393892 DOI: 10.3390/diagnostics14171851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024] Open
Abstract
Aortic arch anomalies encompass a diverse spectrum of conditions. Elucidating the prevalence of these anomalies, their impact on patient wellbeing, and the most effective diagnostic tools are crucial steps in ensuring optimal patient care. This paper aims to explore the various presentations of aortic arch anomalies, emphasizing the remarkable utility of computed tomography (CT) angiography in their definitive diagnosis and characterization. We conducted a retrospective study on patients who were submitted to the CT angiography of the thoracic aorta or supra-aortic trunks, or the contrast-enhanced CT scans of the thorax and/or cervical region between January 2021 and February 2024 in our Hospital. Out of the total of 2350 patients, 18 were diagnosed with aortic arch anomalies, with an average age of approximately 55 years. The aortic arch anomalies identified in the study were as follows: left aortic arch with the aberrant origin of the right subclavian artery, right aortic arch (types I and II), double aortic arch, aortic coarctation, aortic pseudocoarctation, and ductus diverticulum. Although often asymptomatic, aortic arch anomalies require recognition and CT using advanced post-processing techniques is the optimal diagnostic method with the ability to also identify other associated cardiac or vascular malformations.
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Affiliation(s)
- Radu Octavian Baz
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
- Department of Radiology and Medical Imaging, Faculty of Medicine, "Ovidius" University, 900527 Constanta, Romania
| | - Deria Refi
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
| | - Cristian Scheau
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
| | - Any Axelerad
- Department of Neurology, Faculty of Medicine, "Ovidius" University, 900527 Constanta, Romania
| | - Radu Andrei Baz
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
| | - Cosmin Niscoveanu
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
- Department of Radiology and Medical Imaging, Faculty of Medicine, "Ovidius" University, 900527 Constanta, Romania
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Nocera A, Nachira D, Cancellieri A, Margaritora S, Congedo MT. A Unique Association of Right-Sided Aortic Arch With Kommerell's Diverticulum, Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia, and Typical Carcinoid: A Case Report. Cureus 2024; 16:e68164. [PMID: 39347134 PMCID: PMC11439110 DOI: 10.7759/cureus.68164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 10/01/2024] Open
Abstract
Our case presents a unique occurrence marking the first documentation of a connection between a typical carcinoid in the context of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) and vascular anomalies, including a right-sided aortic arch with Kommerell's diverticulum. Kommerell's diverticulum is a rare congenital anomaly. The lusoria subclavian artery, another developmental anomaly, arises from the right aortic arch instead of the typical left side. Neuroendocrine cells may contribute to lung disease pathogenesis by altering their physiology before clinical symptoms appear. A 56-year-old woman with an unyielding chronic cough underwent diagnostic evaluation, unveiling rare vascular anomalies alongside a pulmonary nodule. Radiological investigations disclosed a solid nodule in the middle lobe, accompanied by proximal right-sided aortic arch ectasia and an aberrant left subclavian artery. Following multidisciplinary deliberation, thoracic and vascular surgeons elected for surgical nodule resection. Utilizing uniportal video-assisted thoracoscopic surgery, the procedure revealed the anomaly of the right-sided aortic arch. Preliminary histological examination indicated a low-grade pulmonary carcinoid, obviating the need for further lymphadenectomy due to its low malignancy potential. Subsequent histological analysis confirmed a well-differentiated neuroendocrine tumor G1 consistent with typical carcinoid within a DIPNECH framework. Currently, the patient is in follow-up. This case underscores the importance of multidisciplinary evaluation and tailored surgical approaches for managing patients with rare vascular anomalies and pulmonary nodules, emphasizing the requisite comprehensive preoperative assessment and collaborative efforts among diverse medical specialties to optimize outcomes.
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Affiliation(s)
- Adriana Nocera
- Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, ITA
| | - Dania Nachira
- Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, ITA
| | - Alessandra Cancellieri
- Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, ITA
| | - Stefano Margaritora
- Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, ITA
| | - Maria Teresa Congedo
- Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, ITA
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Mahavar R, Singh A, Mehta Y. Assessing the Position of the Intra-aortic Balloon Pump Catheter Tip in Right-Sided Aortic Arch. Ann Card Anaesth 2024; 27:290-292. [PMID: 38963377 PMCID: PMC11315247 DOI: 10.4103/aca.aca_6_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/05/2024] [Accepted: 02/20/2024] [Indexed: 07/05/2024] Open
Affiliation(s)
- Ravi Mahavar
- Department of Cardiac Anaesthesia, Institute of Critical Care and Anaesthesiology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Ajmer Singh
- Department of Cardiac Anaesthesia, Institute of Critical Care and Anaesthesiology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Cardiac Anaesthesia, Institute of Critical Care and Anaesthesiology, Medanta-The Medicity, Gurugram, Haryana, India
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024; 118:5-115. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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Takagi S, Goto Y, Yanagisawa J, Ogihara Y, Okawa Y. Thoracic Endovascular Aortic Repair Without Subclavian Revascularization of a Ruptured Kommerell Diverticulum. JACC Case Rep 2024; 29:102349. [PMID: 38665999 PMCID: PMC11041829 DOI: 10.1016/j.jaccas.2024.102349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/04/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
A ruptured Kommerell diverticulum is extremely rare. This is the first report of thoracic endovascular aortic repair without subclavian revascularization of a ruptured Kommerell diverticulum with a right-sided aortic arch. However, decisions regarding subclavian revascularization should be individualized based on the patient's anatomy and clinical presentation.
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Affiliation(s)
- Sho Takagi
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yoshihiro Goto
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Junji Yanagisawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yui Ogihara
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
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Triantafyllou G, Melissanidis S, Vlychou M, Tsakotos G, Pantazis N, Vassiou K, Tsiouris C, Piagkou M. Right-Sided Aortic Arch: A Computed Tomography Angiography Investigation, A Systematic Review with Meta-Analysis. J Clin Med 2024; 13:3105. [PMID: 38892815 PMCID: PMC11172921 DOI: 10.3390/jcm13113105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: The right-sided aortic arch (RAA) is an uncommon variation of the aortic arch (AA), characterized by the aorta crossing over the right main bronchus. In the RAA, the descending aorta can be found on either the right or left side of the spine. The current study comprises a comprehensive retrospective computed tomography angiography (CTA) investigation into the prevalence of the RAA within the Greek population. Additionally, we will conduct a systematic review and meta-analysis to elucidate both common and rare morphological variants of the RAA. This research is significant as it sheds light on the prevalence and characteristics of the RAA in a specific population, providing valuable insights for clinical practice. Methods: Two hundred CTAs were meticulously investigated for the presence of a RAA. In addition, the PubMed, Google Scholar, and Scopus online databases were thoroughly searched for studies referring to the AA morphology. The R programming language and RStudio were used for the pooled prevalence meta-analysis, while several subgroup analyses were conducted. Results: Original study: A unique case of 200 CTAs (0.5%) was identified with an uncommon morphology. The following branches emanated from the RAA under the sequence: the right subclavian artery (RSA), the right common carotid artery (RCCA), the left common carotid artery (LCCA), and the left vertebral artery (LVA) in common origin with the aberrant left subclavian artery (ALSA). The ALSA originated from a diverticulum (of Kommerell) and followed a retroesophageal course. Systematic Review and Meta-Analysis: Sixty-two studies (72,187 total cases) met the inclusion criteria. The pooled prevalence of the RAA with a mirror-image morphology was estimated at 0.07%, and the RAA with an ALSA was estimated at <0.01%. Conclusions: AA anomalies, specifically the RAA, raise clinical interest due to their coexistence with developmental heart anomalies and possible interventional complications. Congenital heart anomalies, such as the Tetralogy of Fallot and patent foramen ovale, coexisted with RAA mirror-image morphology.
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Affiliation(s)
- George Triantafyllou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (G.T.); (C.T.)
| | | | - Marianna Vlychou
- Department of Radiology, University Hospital of Larissa, 413 34 Larissa, Greece;
| | - George Tsakotos
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (G.T.); (C.T.)
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian, University of Athens, 115 27 Athens, Greece;
| | - Katerina Vassiou
- Department of Anatomy, Faculty of Medicine, University of Thessaly, 413 34 Larissa, Greece;
| | - Christos Tsiouris
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (G.T.); (C.T.)
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (G.T.); (C.T.)
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Hu B, Li J, Li L, Yin H, Zheng C, Fan L. Neuro-Interventional Diagnosis and Treatment Using the Right Transradial Approach in Patients with Aberrant Right Subclavian Artery. World Neurosurg 2024; 185:e1330-e1337. [PMID: 38521216 DOI: 10.1016/j.wneu.2024.03.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To assess the effectiveness and safety of neurological interventions using the right transradial approach (R-TRA) in patients with aberrant right subclavian artery (ARSA). METHODS We retrospectively analyzed cases that underwent cerebral angiography and interventions at Huangpi District People's Hospital from January 2023 to July 2023. Out of 335 cases, 5 patients with ARSA were identified. RESULTS All 5 cases underwent diagnostic cerebral angiography via R-TRA. Two of the patients received interventions via R-TRA: 1 underwent right internal carotid artery balloon dilation angioplasty, while another underwent left vertebral artery stenting. No surgery-related complications were observed during these procedures. CONCLUSIONS R-TRA proves to be a safe and effective option for neuro-interventional surgery in patients with ARSA.
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Affiliation(s)
- Bin Hu
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Jing Li
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China.
| | - Liang Li
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Hao Yin
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Chong Zheng
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
| | - Liu Fan
- Department of Neurology, Huangpi District People's Hospital affiliated to Jianghan University, Wuhan, P.R. China
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Shinjo H, Satokawa H, Wakamatsu H, Yokoyama H. A case of Kommerell diverticulum in adolescence presented with dysphagia. Surg Case Rep 2024; 10:104. [PMID: 38678483 PMCID: PMC11056346 DOI: 10.1186/s40792-024-01904-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/20/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Kommerell diverticulum (KD) with right aortic arch and aberrant left subclavian artery (ALSCA) is a rare congenital aortic anomaly. To improve organ compression symptoms and avoid rupture of aneurysms in adulthood (19 years old-), surgical treatment is considered the only curative option. However, in childhood (-18 years old), several problems regarding approach and technique selection have been reported. Surgical treatment for KD in infancy (birth-2 years old) has been reported recently, but rarely in adolescence (13-19 years old). We herein report a case of KD in which the patient underwent graft replacement during adolescence. CASE PRESENTATION A 13-year-old boy was admitted to our hospital presenting with dysphagia and body weight loss. Esophagography showed upper esophageal stenosis caused by extrinsic compression. Contrast-enhanced computer tomography showed saccular aneurysm formation of KD with right aortic arch (RAA) and ALSCA. Elective surgery including KD resection and graft replacement of the descending aorta was performed via right thoracotomy under partial extracorporeal circulation. The ALSCA was reconstructed by graft interposition. No postoperative complication was observed. Follow-up esophagography showed no residual stenosis. CONCLUSION We experienced a case of KD with dysphagia and weight loss in adolescence, which was successfully treated with surgery. Graft replacement could be an effective treatment option, facilitating recovery even during the growth period.
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Affiliation(s)
- Hiroharu Shinjo
- Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
| | - Hirono Satokawa
- Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroki Wakamatsu
- Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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13
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Ishikawa K, Ohtake Y, Fukuda M, Endo H, Nakamura H. Dysplastic aberrant left subclavian artery originating from a thoracic intersegmental artery associated with a right aortic arch. Surg Radiol Anat 2024; 46:519-522. [PMID: 38480591 DOI: 10.1007/s00276-024-03333-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/23/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE A right aortic arch (RAA) is a rare vascular anomaly that often coexists with an aberrant left subclavian artery (ALSA). Due to the rarity of RAA, the development of an ALSA is not well understood. METHOD We describe a case in which a 58-year-old man who was scheduled to undergo posterior decompression and fusion surgery for thoracic ossification of the posterior longitudinal ligament from Th1 to Th3 was found to have a RAA and an ALSA. RESULTS Preoperative computed tomography angiography demonstrated a RAA and an ALSA. The ALSA was extremely tortuous and ran in the paraspinal muscles behind the thoracic laminae, which meant it was in the surgical field. The ALSA arose from the descending aorta and bifurcated into the left segmental arteries of Th1 and Th2, and also bifurcated into the left vertebral artery, which had a normal subsequent course. The dysplastic ALSA was considered to have developed from the thoracic intersegmental artery. Based on preoperative examination findings, we performed spinal surgery without vessel injury. CONCLUSION We report a rare case of a dysplastic ALSA that developed from the thoracic intersegmental artery with a RAA. The knowledge of this anomaly provides safety in spinal surgery of the cervicothoracic junction.
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Affiliation(s)
- Kohei Ishikawa
- Department of Neurosurgery, Nakamura Memorial Hospital, 291, Minami 1-jo Nishi 14-chome, Chuo-ku, Hokkaido, Hokkaido, 060-8570, Japan.
| | - Yasufumi Ohtake
- Department of Neurosurgery, Nakamura Memorial Hospital, 291, Minami 1-jo Nishi 14-chome, Chuo-ku, Hokkaido, Hokkaido, 060-8570, Japan
| | - Mamoru Fukuda
- Department of Neurosurgery, Nakamura Memorial Hospital, 291, Minami 1-jo Nishi 14-chome, Chuo-ku, Hokkaido, Hokkaido, 060-8570, Japan
| | - Hideki Endo
- Department of Neurosurgery, Nakamura Memorial Hospital, 291, Minami 1-jo Nishi 14-chome, Chuo-ku, Hokkaido, Hokkaido, 060-8570, Japan
| | - Hirohiko Nakamura
- Department of Neurosurgery, Nakamura Memorial Hospital, 291, Minami 1-jo Nishi 14-chome, Chuo-ku, Hokkaido, Hokkaido, 060-8570, Japan
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14
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Bartoli CR, Rajakumar CJ, Elmore JR, Ziemer G. Contralateral Thoracotomy With Extracorporeal Circulation for Reoperative Resection of a Kommerell Diverticulum. World J Pediatr Congenit Heart Surg 2024; 15:242-245. [PMID: 38378189 DOI: 10.1177/21501351231224385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Reoperative vascular ring surgery is uncommon. Standard redo ipsilateral thoracotomy may present technical challenges and risks. We describe a patient with right aortic arch, aberrant left subclavian artery, and a Kommerell diverticulum in whom previous vascular ring division via left thoracotomy did not relieve dysphagia. Three years after the unsuccessful operation, left subclavian-carotid transposition via supraclavicular incision followed by resection of the Kommerell diverticulum via right thoracotomy with extracorporeal circulation relieved symptoms. Contralateral thoracotomy with extracorporeal circulation provides a safe, alternative approach to redo ipsilateral thoracotomy for resection of a symptomatic Kommerell diverticulum. We review the literature on the incidence, surgical indications, and operative approaches to manage symptoms from a Kommerell diverticulum.
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Affiliation(s)
- Carlo R Bartoli
- Division of Cardiothoracic Surgery, Geisinger Medical Center, Danville, PA, USA
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | | | - James R Elmore
- Division of Vascular Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Gerhard Ziemer
- Division of Cardiothoracic Surgery, Geisinger Medical Center, Danville, PA, USA
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15
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Valenzuela-Fuenzalida JJ, Orellana-Donoso M, Perez-Jiménez D, Farfán-Cabello E, Gold-Semmler M, Becerra-Farfan A, Román C, Nova-Baeza P. Systematic review and meta-analysis of right subclavian artery variants and their correlation with cervical-thoracic clinical conditions. Medicine (Baltimore) 2024; 103:e36856. [PMID: 38394517 PMCID: PMC11309723 DOI: 10.1097/md.0000000000036856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/13/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND A high incidence of anatomical variations in the origin of the branches of the aortic arch has been reported, Nowadays, this variation is considered the most frequent in the aortic arch, its prevalence being estimated between 0.5% and 2.5% of the population. To understand its origin, knowledge of embryonic development is necessary. METHODS We searched the MEDLINE, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, and Latin-American literature and caribean of health sciences databases with dates ranging from their inception to June 2023. Study selection, data extraction, and methodological quality were assessed with the guaranteed tool for anatomical studies (Anatomical Quality Assurance). Finally, the pooled prevalence was estimated using a random effects model. RESULTS Thirty-nine studies were found that met the eligibility criteria. Twenty studies with a total of 41,178 subjects were included in the analysis. The overall prevalence of an ARSA variant was 1% (95% confidence interval = 1%-2%), the clinical findings found are that if ARSA is symptomatic it could produce changes in the hemodynamic function of the thoracocervical region in addition to other associated symptomatic complications in surrounding structures. CONCLUSIONS ARSA can cause several types of alterations in the cervical or thoracic region, resulting in various clinical complications, such as lusory dysphagia. Hence, knowing this variant is extremely important for surgeons, especially those who treat the cervico-thoracic region. The low prevalence of ARSA means that many professionals are completely unaware of its existence and possible course and origin. Therefore, this study provides detailed knowledge of ARSA so that professionals can make better diagnoses and treatment of ARSA.
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Affiliation(s)
- Juan José Valenzuela-Fuenzalida
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
- Department of Morphology and Function, Faculty of Health, University of the Americas Santiago, Chile
| | - Mathias Orellana-Donoso
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
- Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Daniela Perez-Jiménez
- Department of Morphology and Function, Faculty of Health, University of the Americas Santiago, Chile
| | - Emilio Farfán-Cabello
- Departamento de Anatomía, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marjorie Gold-Semmler
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
| | - Alvaro Becerra-Farfan
- Departamento de Ciencias Química y Biológicas Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins
| | - Camila Román
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
| | - Pablo Nova-Baeza
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 102] [Impact Index Per Article: 102.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
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17
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Wang Y, Li S, Jin M, Xue Y, Wang D, Zhou Q. Surgical treatment for right-side aortic arch concomitant with Kommerell's diverticulum: techniques selection and follow-up results. Eur J Med Res 2024; 29:10. [PMID: 38172972 PMCID: PMC10762982 DOI: 10.1186/s40001-023-01595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Right-side aortic arch concomitant with Kommerell's diverticulum (KD) is a rare and complex ailment, and there is no consensus on the optimal strategy to deal with this congenital anomaly. We retrospectively analyzed and summary of the cases treated in our center with individual treatment methods for different situations. METHODS Between September 2018 and December 2021, 10 patients experienced surgical therapy at our institution who presented with a Kommerell's diverticulum arising from an aberrant subclavian artery from the right-side aortic arch. Four main surgical techniques were applied to those patients: 1. total arch replacement with frozen elephant trunk implantation (n = 2); 2. hybrid procedure combining open arch repair and endovascular intervention (n = 1); 3. total endovascular repair using thoracic endovascular aortic repair (TEVAR) with or without left subclavian artery (LSCA) revascularization (n = 6); 4. direct repair underwent endoaneurysmorrhaphy. Clinical characteristics and outcomes were collected. RESULTS The mean age of these 10 patients was 56.5 years (range 29-79 years) and only 1 woman. The pathology includes aortic dissection (n = 6) and aneurysm (n = 4). The mean diverticulum size was 41.4 [24.2-56.8] mm. There were no in-hospital deaths, and the median hospital stay was 22 [15-43] days. During the follow-up period (21.4 months, 1-44 months), one died of an unknown cause and one died of esophageal fistula. Two patients underwent second-stage endovascular intervention for distal lesion. And none of the patients had endoleak during the follow-up period. CONCLUSIONS Each of the procedures we have mentioned here has its advantages and disadvantages; individualized treatment should meet the appropriate indications. A single-branched stent graft is feasible and effective in the treatment of aortic disease combined with Kommerell's diverticulum.
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Affiliation(s)
- Yali Wang
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Shuchun Li
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Min Jin
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Yunxing Xue
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Dongjin Wang
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Qing Zhou
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China.
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China.
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18
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Mogilevets EV, Sushko AA, Zhuk IG, Bekish AK, Sluchich OI. [Right-sided upper lobectomy in a patient with right aortic arch: a case report and literature review]. Khirurgiia (Mosk) 2024:90-96. [PMID: 38344965 DOI: 10.17116/hirurgia202402190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
A right aortic arch is an anomaly of prenatal development characterized by location of aortic arch to the right from tracheal-esophageal complex. This variant of anatomy is usually asymptomatic and diagnosed accidentally. We performed open upper lobectomy for cancer of the upper lobe of the right lung in a patient with aortic arch dextraposition. Classical right-sided upper lobectomy in patients with right aortic arch is associated with certain difficulties. The most difficult objective is total excision of lymph nodes because trachea is hidden under aortic arch. A specific complication may be postoperative hoarseness associated with iatrogenic damage to the right recurrent laryngeal nerve.
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Affiliation(s)
| | - A A Sushko
- Grodno State Medical University, Grodno, Belarus
| | - I G Zhuk
- Grodno State Medical University, Grodno, Belarus
| | - A K Bekish
- Grodno State Medical University, Grodno, Belarus
| | - O I Sluchich
- Grodno State Medical University, Grodno, Belarus
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Akilu W, Feng Y, Zhang XX, Li SL, Ma XT, Hu M, Cheng C. Carotid-subclavian bypass and endovascular aortic repair of Kommerell’s diverticulum with aberrant left subclavian artery: A case report. World J Clin Cases 2023; 11:8038-8043. [DOI: 10.12998/wjcc.v11.i33.8038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/14/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Kommerell’s diverticulum (KD) with aberrant left subclavian artery is a rare congenital deformity and also has very little research literature about it (35% of case study). There are three types of aortic arch diverticulum. Even literature concerning the treatment options are limited.
CASE SUMMARY We present a case report of a 50-year-old male with KD in the right aortic arch with aberrant left subclavian artery. We conducted a total endovascular repair procedure, which is innovative and will spread more light in the medical world. Our patient has no past medical history and is a non-smoker and non-alcoholic. Patient presented with shortness of breath, chest pain and dizziness for six months. Blood tests were done and computerized tomography (CT) angiogram of the chest confirmed the diagnosis, illustrating showed a 3.9 cm KD. On Day 1, the CT angiogram showed mild dilatation of the thoracic aorta, adjacent esophagus, trachea was compressed and displaced. Surgery was planned as the treatment modality. Carotid-Subclavian artery bypass and endovascular aortic repair was conducted. We used prolene 5-0 C1 sutures to precisely anastomose a 6-mm Dacron graft to the left subclavian artery. Haemostasis was secured and wounds were closed. Protamine was administered and patient was shifted to intensive care unit. Post-operative, patient responded favorably and was discharged. Regular follow-up is done.
CONCLUSION The procedure we performed is novel. This will help the cardio-thoracic surgeons a better insight about the full procedures we conducted, thereby bringing more light and better treatment options in managing KD with aberrant subclavian artery.
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Affiliation(s)
- Wajeehullahi Akilu
- Division of Cardiothoracic Surgery and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Yi Feng
- Division of Cardiothoracic Surgery and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xiao-Xue Zhang
- Division of Cardiothoracic Surgery and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Shi-Liang Li
- Division of Cardiothoracic Surgery and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xian-Tao Ma
- Division of Cardiothoracic Surgery and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Min Hu
- Division of Cardiothoracic Surgery and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Cai Cheng
- Division of Cardiothoracic Surgery and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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20
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Yabu N, Minami T, Izubuchi R, Kojima T, Yamazaki I. Total arch replacement with frozen elephant trunk technique for Kommerell's diverticulum with a right-sided aortic arch and aberrant left subclavian artery. J Cardiothorac Surg 2023; 18:317. [PMID: 37950295 PMCID: PMC10638817 DOI: 10.1186/s13019-023-02425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Kommerell's diverticulum with a right-sided aortic arch and aberrant left subclavian artery is uncommon. We perforemed a single-stage procedure with the frozen elephant trunk technique. CASE PRESENTATION A 62-year-old man underwent aortic dissection a year ago, and computerized tomographic angiography performed at that time revealed a right aortic arch, Kommerell's diverticulum (42 mm), and an aberrant left subclavian artery. We performed one-stage repair through median sternotomy. The cervical branches were exposed during the operation, and a deep hypothermic circulatory arrest with antegrade cerebral perfusion was established. The aorta was transected distally to the origin of the left carotid artery. We inserted a stent graft into the aorta, followed by peripheral anastomosis using a premade 5-branch Dacron graft. The right subclavian artery and the aorta were reconstructed, and the remaining cervical branches were reconstructed after the cross-clamp had been released. CONCLUSIONS Total arch replacement through median sternotomy was performed for the right aortic arch, Kommerell's diverticulum, and aberrant left subclavian artery. The frozen elephant trunk technique is allowed to perform a one-stage operation safely.
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Affiliation(s)
- Naoto Yabu
- Cardiovascular Surgery, Fujisawa City Hospital, Fujisawa 2-6-1, Fujisawa, Kanagawa, 251-8550, Japan.
| | - Tomoyuki Minami
- Department of Surgery, Yokohama City University, Fukuura 3-9, Kanazawa-ku, Yokohama, Kanagawa, 236-004, Japan
| | - Ryo Izubuchi
- Cardiovascular Surgery, Fujisawa City Hospital, Fujisawa 2-6-1, Fujisawa, Kanagawa, 251-8550, Japan
| | - Takahiro Kojima
- Cardiovascular Surgery, Fujisawa City Hospital, Fujisawa 2-6-1, Fujisawa, Kanagawa, 251-8550, Japan
| | - Ichiya Yamazaki
- Cardiovascular Surgery, Fujisawa City Hospital, Fujisawa 2-6-1, Fujisawa, Kanagawa, 251-8550, Japan
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Solano A, Pizano A, Azam J, Gonzalez-Guardiola G, Siah M, Chamseddin K, Prakash V, Kirkwood ML, Shih M. Kommerell's Diverticulum in a Right-Sided Aortic Arch With an Aberrant Left Subclavian Artery Hybrid Repair. Vasc Endovascular Surg 2023; 57:954-959. [PMID: 37310394 PMCID: PMC10543133 DOI: 10.1177/15385744231183310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Kommerell's diverticulum (KD) with a right aortic arch (RAA) and aberrant left subclavian artery (aLSCA) is a rare congenital anomaly of the aortic arch. Treatment is not well defined due to its uncommon presentation, with rupture and dissection risk rates of up to 53%. CASE SUMMARY A 54-year-old male with a history of chronic obstructive pulmonary disease (COPD) and hypertension presented with difficulty breathing during exercise without dysphagia. Follow-up computerized tomography angiogram (CTA) revealed the presence of a RAA and aLSCA arising from the descending thoracic aorta with an adjacent 58 × 41-mm KD and tracheal and esophageal displacement. Due to the size of the KD, risk of rupture, unsuitable anatomy for total endovascular aortic repair (EVAR), and high COPD burden, the patient was planned to undergo a hybrid surgical repair. Left common carotid (LCCA) artery to LSCA bypass, full aortic debranching, LSCA embolization and percutaneous thoracic endovascular aortic repair (TEVAR) were performed. Successful device position and exclusion of the diverticulum and aneurysmal aorta were observed after completion thoracic aortogram. 18-month follow-up CTA demonstrated patency of the LSCA to LCCA bypass graft and arch vessel branches, as well as stable exclusion of the KD. Persistence of a type II endoleak originated at the right first posterior intercostal artery has been noted and is being followed conservatively since no sac growth has occurred. CONCLUSION We highlight the presence of a KD with RAA and aberrant subclavian artery, a rare congenital anatomic variation of the aortic arch with complex anatomy. Surgical planning must be individualized according to comorbidities and anatomical variations identified on imaging and 3D reconstructions.
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Affiliation(s)
- Antonio Solano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Alejandro Pizano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Jawaher Azam
- Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA Presented at the poster session of the Critical Issues America Annual Meeting. Miami, FL, February 10-11, 2023
| | - Gerardo Gonzalez-Guardiola
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Michael Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Khalil Chamseddin
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Vivek Prakash
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Melissa L. Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
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22
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Clark AJ, Drullinsky D, Pradella M, Mehta CK. Aortic arch and frozen elephant trunk repair of a right-sided aortic arch with pseudoaneurysm rupture. J Vasc Surg Cases Innov Tech 2023; 9:101258. [PMID: 37520168 PMCID: PMC10382922 DOI: 10.1016/j.jvscit.2023.101258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/05/2023] [Indexed: 08/01/2023] Open
Abstract
A 53-year-old man with a history of vascular ring repair secondary to a right-sided aortic arch with a retroesophageal subclavian artery and ligamentum arteriosum to the descending thoracic aorta presented to our institution with a large aortic pseudoaneurysm of the distal aortic arch. Computed tomography demonstrated a right-sided aortic arch with a 5.8-cm pseudoaneurysm arising from the distal arch with concern for rupture. The patient underwent successful two-stage repair, including a left carotid artery to subclavian artery bypass, followed by total arch replacement with the frozen elephant trunk technique. He recovered well postoperatively, and computed tomography showed complete, successful repair of the pseudoaneurysm.
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Affiliation(s)
- Aaron J. Clark
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Drullinsky
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maurice Pradella
- Department of Radiology, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Christopher K. Mehta
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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23
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Tallarita T, Rogers RT, Bower TC, Stone W, Farres H, Money SR, Colglazier JJ. Characterization and surgical management of aberrant subclavian arteries. J Vasc Surg 2023; 77:1006-1015. [PMID: 36565775 DOI: 10.1016/j.jvs.2022.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Aberrant subclavian arteries (aSCAs), with or without aortic pathology, are uncommon. The purpose of the present study was to review our experience with the surgical management of aSCA. METHODS We performed a retrospective review of patients who had undergone surgery for an aSCA between 1996 and 2020. Symptomatic and asymptomatic patients were included. The primary end points were ≤30-day and late mortality. The secondary end points were ≤30-day complications, graft patency, and reinterventions. RESULTS A total of 46 symptomatic and 3 asymptomatic patients with aSCA had undergone surgery (31 females [62%]; median age, 45 years). An aberrant right subclavian artery was present in 38 (78%) and an aberrant left subclavian artery in 11 patients (22%). Of the 49 patients, 41 (84%) had had a Kommerell diverticulum (KD) and 11 (22%) had had a concomitant distal arch or proximal descending thoracic aortic aneurysm. Symptoms included dysphagia (56%), dyspnea (27%), odynophagia (20%), and upper extremity exertional fatigue (16%). Five patients (10%) had required emergency surgery. The aSCA had been treated by transposition in 32, a carotid to subclavian bypass in 11, and an ascending aorta to subclavian bypass in 6. The KD was treated by resection and oversewing in 19 patients (39%). Fifteen patients (31%) had required distal arch or proximal descending thoracic aortic replacement for concomitant aortic disease and/or KD treatment. Thoracic endovascular aortic repair was used to exclude the KD in six patients (12%). Seven patients (14%) had undergone only bypass or transposition. The 30-day complications included one death from pulseless electrical activity arrest secondary to massive pulmonary embolism. The 30-day major complications (14%) included acute respiratory failure in three, early mortality in one, stroke in one, non-ST-elevation myocardial infarction in one, and temporary dialysis in one patient. The other complications included chylothorax/lymphocele (n = 5; 10%), acute kidney injury (n = 2; 4%), pneumonia (n = 2; 4%), wound infection (n = 2; 4%), atrial fibrillation (n = 2; 4%), Horner syndrome (n = 2; 4%), lower extremity acute limb ischemia (n = 1; 2%), and left recurrent laryngeal nerve injury (n = 1; 2%). At a median follow-up of 53 months (range, 1-230 months), 40 patients (82%) had had complete symptom relief and 9 (18%) had experienced improvement. Six patients had died at a median of 157 months; the deaths were not procedure or aortic related. The primary patency was 98%. Reintervention at ≤30 days had been required for two patients (4%) for ligation of lymphatic vessels and bilateral lower extremity fasciotomy after proximal descending thoracic aorta replacement. One patient had required late explantation of an infected and occluded carotid to subclavian bypass graft, which was treated by cryopreserved allograft replacement. CONCLUSIONS Surgical treatment of the aSCA can be accomplished with low major morbidity and mortality with excellent primary patency and symptom relief.
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Affiliation(s)
- Tiziano Tallarita
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Richard T Rogers
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
| | - Thomas C Bower
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - William Stone
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ
| | - Houssam Farres
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL
| | - Samuel R Money
- Division of Vascular Surgery, Ochsner Health Center, New Orleans, LA
| | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
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24
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Velandia-Sánchez A, Gómez-Galán S, Gallo-Bernal S, Polania-Sandoval CA, Pineda-Rodríguez IG, Florez-Amaya P, Sanabria-Arévalo LM, Senosiain-González J, Barrera-Carvajal JG, Umana JP, Camacho-Mackenzie J. Emergent hybrid surgical approaches for non-dissecting ruptured Kommerell's aneurysm: a case report series. J Cardiothorac Surg 2023; 18:93. [PMID: 36964599 PMCID: PMC10037773 DOI: 10.1186/s13019-023-02156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/24/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Kommerell's aneurysm is a saccular or fusiform dilatation found in 3-8% of Kommerell's diverticulum cases. A non-dissecting rupture rate of 6% has been reported. If ruptured, emergent surgical correction is usually granted. However, evidence regarding the optimal surgical approach in this acute setting is scarce. In this case report series, we aim to describe our experience managing type-1 non-dissecting ruptured Kommerell's aneurysm with hybrid emergent surgical approaches. CASES PRESENTATION From January 2005 to December 2020, three cases of type-1 non-dissecting ruptured Kommerell's aneurysm requiring emergent surgical repair were identified. The mean age was 66.67 ± 7.76 years, and 3/3 were male. The most common symptoms were atypical chest pain, dyspnoea, and headache (2/3). The mean aneurysm's diameter was 63.67 ± 5.69 mm. Frozen Elephant Trunk was the preferred surgical approach (2/3). The Non-Frozen Elephant Trunk patient underwent a hybrid procedure consisting of a supra-aortic debranching and a zone-2 stent-graft deployment. We found a mean clamp time of 140 ± 60.75 min, cardiac arrest time of 51.33 ± 3.06 min, and a hospital stay of 13.67 ± 5.51 days. The most common complications were surgical-site infection and shock (2/3). Only one patient died (1/3). CONCLUSION Evidence of management for non-dissecting ruptured Kommerell's aneurysms is scarce. Additional, robust, and more extensive studies are required. The selection of the appropriate surgical approach is challenging, and each patient should be individualized. Frozen Elephant Trunk was feasible for patients requiring emergent surgical repair in our centre. However, other hybrid or open procedures can be performed.
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Affiliation(s)
- Alejandro Velandia-Sánchez
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia.
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
| | - Sebastián Gómez-Galán
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Sebastian Gallo-Bernal
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- Division of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Camilo A Polania-Sandoval
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Ivonne G Pineda-Rodríguez
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
| | - Paula Florez-Amaya
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Lina M Sanabria-Arévalo
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | | | - Juan G Barrera-Carvajal
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Juan P Umana
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Jaime Camacho-Mackenzie
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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25
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Erhiawarie F, Chioma OE, Rahim O, Ansar S, Adabanya U, Omole AE, Awosika A. Right Subclavian Artery With Kommerell's Diverticulum: A Rare Cause of Dysphagia. Cureus 2023; 15:e35812. [PMID: 37033524 PMCID: PMC10074752 DOI: 10.7759/cureus.35812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/08/2023] Open
Abstract
Kommerell's diverticulum is an embryologic developmental anomaly of the aortic arch wherein a diverticulum arises from either the left or the right aortic arch. It results due to the persistence of the remnant of the fourth dorsal aortic arch. We present a case of a 66-year-old female presenting with complaints of throat pain and difficulty swallowing. A computed tomography (CT) scan of the neck with contrast revealed an incidental finding of an aberrant right subclavian artery with associated diverticula of Kommerell, measuring up to 1 cm, causing a mass effect on the esophagus and posterior trachea. A diagnosis of dysphagia lusoria was established, and an upper gastrointestinal (GI) series revealed narrowing of the esophagus from posterior extrinsic compression. The patient was discharged home for nutrition optimization with a percutaneous endoscopic gastrostomy (PEG) tube due to significant weight loss from the inability to swallow before proceeding with surgery to repair the aberrant right subclavian artery.
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26
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Shadanov AA, Sirota DA, Lyashenko MM, Kobelev E, Khomushku DOV, Chernyavskiy AM. [Hybrid treatment of Kommerell diverticulum and giant aneurysm of intra-thoracic segment of aberrant left subclavian artery]. Khirurgiia (Mosk) 2023:90-93. [PMID: 36800875 DOI: 10.17116/hirurgia202303190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Kommerell's diverticulum causes compression of the esophagus, trachea and laryngeal nerve between the aberrant mouth of the left subclavian artery and ascending aorta. This leads to dysphagia or shortness of breath. We describe hybrid treatment of the right aortic arch with Kommerell's diverticulum and giant aneurysm of the aberrant left subclavian artery.
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Affiliation(s)
- A A Shadanov
- Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - D A Sirota
- Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - M M Lyashenko
- Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - E Kobelev
- Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - D-O V Khomushku
- Meshalkin National Medical Research Center, Novosibirsk, Russia
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27
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Kasahara H, Shin H, Inoue Y. Acute aortic dissection with an aberrant right subclavian artery resulting in rapid false lumen enlargement: a case report. GENERAL THORACIC AND CARDIOVASCULAR SURGERY CASES 2023; 2:4. [PMID: 39517025 PMCID: PMC11533584 DOI: 10.1186/s44215-022-00020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2024]
Abstract
BACKGROUND An aberrant right subclavian artery complicated by acute aortic dissection has been reported. Aneurysmal degeneration in the descending aorta adjacent to the Kommerell diverticulum in older patients has also been reported. There are concerns regarding the anatomic and pathological aspects of an aberrant right subclavian artery accompanying the Kommerell diverticulum with respect the surgical strategy for acute aortic dissection. CASE PRESENTATION We report the case of a 79-year-old man with an aberrant right subclavian artery who developed acute aortic dissection (DeBakey IIIa) and rapid enlargement of the false lumen with deteriorating dysphagia and back pain. Total arch replacement with the frozen elephant trunk technique was performed. The aberrant right subclavian artery was closed using a stent graft proximally and was ligated distally at the right side of the posterior mediastinum. To prevent injury to the esophagus, the aberrant right subclavian artery was identified by lifting the right side of the thoracic wall using a thoracotomy device for internal thoracic artery harvest to expose the dorsal circumference of the superior vena cava. Additionally, the right subclavian artery was reconstructed using an extra-anatomical bypass. CONCLUSIONS This surgical strategy could be useful in patients with an aberrant right subclavian artery and the Kommerell diverticulum who require total arch replacement.
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Affiliation(s)
- Hirofumi Kasahara
- Department of Cardiovascular Surgery, Hiratsuka City Hospital, Kanagawa, Japan.
| | - Hankei Shin
- Department of Cardiovascular Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Yoshito Inoue
- Department of Cardiovascular Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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28
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Lombardi F, Mamopoulos A, Benedik J, Katoh M, Kröger K, Gäbel G. How to Treat Type B Aortic Dissections in the Presence of an Aberrant Right Subclavian Artery: A Systematic Review. AORTA (STAMFORD, CONN.) 2023; 11:20-28. [PMID: 36848908 PMCID: PMC9970753 DOI: 10.1055/s-0042-1757948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 07/06/2022] [Indexed: 06/18/2023]
Abstract
An aberrant right subclavian artery (ARSA) is the most common congenital variant of the aortic arch. Usually, this variation is largely asymptomatic, but sometimes it may be involved in aortic dissection (AD). Surgical management of this condition is challenging. The therapeutic options have been enriched in recent decades by establishing individualized endovascular or hybrid procedures. Whether these less invasive approaches bear advantages, and how they have changed the treatment of this rare pathology, is still unclear. Therefore, we conducted a systematic review. We performed a review of literature from the past 20 years (from January 2000 until February 2021) complying with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All reported patients treated for Type B AD in the presence of an ARSA were identified and classified into three groups according to the received therapy (open, hybrid, and total endovascular). Patient characteristics, as well as in-hospital mortality, and major and minor complications were determined and statistically analyzed. We identified 32 relevant publications comprising 85 patients. Open arch repair has been offered to younger patients, but significantly less often in symptomatic patients needing urgent repair. Therefore, the maximum aortic diameter was also significantly larger in the open repair group compared with that in the hybrid or total endovascular repair group. Regarding the endpoints, we did not find significant differences. The literature review revealed that open surgical therapies are preferred in patients presenting with chronic dissections and larger aortic diameters, most likely because they are unsuitable for endovascular aortic repair. Hybrid and total endovascular approaches are more often applied in emergency situations, where aortic diameters remain smaller. All therapies demonstrated good, early, and midterm outcomes. But, these therapies carry potential risks in the long term. Therefore, long-term follow-up data are urgently needed to validate that these therapies are sustainable.
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Affiliation(s)
| | | | | | - Marcus Katoh
- Department of Diagnostic and Interventional Radiology, Helios Clinic, Krefeld, Germany
| | - Knut Kröger
- Department of Vascular Medicine, Helios Clinic, Krefeld, Germany
| | - Gabor Gäbel
- Department of Vascular Surgery, Helios Clinic, Krefeld, Germany
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29
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A systematic review of open, hybrid, and endovascular repair of aberrant subclavian artery and Kommerell's diverticulum treatment. J Vasc Surg 2023; 77:642-649.e4. [PMID: 35850164 DOI: 10.1016/j.jvs.2022.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/16/2022] [Accepted: 07/07/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Aberrant subclavian artery (AScA) with or without associated Kommerell's diverticulum (KD) is the most frequently encountered anomaly of the aortic arch, it may be life threatening, especially when associated with aneurysmal degeneration. The best management is still debated and depends on many clinical and anatomical factors. A systematic review was conducted to assess the current evidence on the treatment options and their efficacy and safety for AscA and KD repairs. METHODS A literature search in PubMed and Cochrane Library was performed, and articles that were published from January 1947 to August 2021 reporting on AscA and KD management were identified. Multicenter studies, single-center series, and case series with three or more patients were considered eligible in the present review. A comparison of outcomes of patients who underwent open surgery (OS), a hybrid approach (HA), and total endovascular repair (ER) (ie, 30-day mortality and stroke were analyzed when available and compared among the three groups (P < .05; Benjamini and Hochberg-adjusted P < .05; Bonferroni-adjusted P < .05). Titles, abstracts, and full texts were evaluated by two authors independently. Primary outcomes included survival rate, perioperative stroke, arm ischemia, and spinal cord ischemia. Endoleak, in the case of HA and ER, and reintervention rates were considered outcomes. RESULTS Three hundred thirty-one articles were initially evaluated and 30 studies, totaling 426 patients treated for AScA with 324 KD, were included. Of the 426 patients, 241 were male (56.5%), and the mean patient age was 57.9 ± 12.0 years. The approach was OS in 228 patients, HA in 147 patients, and ER in 51. Dysphagia was the most common presentation in 133 cases. Aortic rupture was observed in 16 of the 426 patients (3.8%), including 14 AScA/KD (3.3%) aneurysm rupture. KD maximum diameter varied widely from 12.6 to 63.6 mm. The overall 30-day mortality was 20 (4.7%) (OS group 8/228 [3.5%]; HA group 10/147 [6.8%]; ER 2/51 [3.9%]; P = NS). The overall stroke rate was 4.9% (21/426) (OS group 10/228 [4.4%]; HA group 6/147 [4.1%]; ER group 5/51 [9.8%]; P = NS), including nine transient and nondisabling neurological deficits. Overall secondary procedures for complications were reported in 36 of the 426 cases (8.4%), mostly owing to endoleak. Follow-up varied from 13 to 74 months. CONCLUSIONS This systematic review assessed the current outcomes of the three types of therapeutic management for AScA and KD and demonstrated that they are all relatively safe and effective, providing satisfactory early and midterm outcomes. Long-term outcomes are warranted, especially for total ERs since the long-term durability of stent grafts remains unknown.
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30
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Colpitts DK, Ragan MV, Spinosa DJ, Ryan L, Mukherjee D. Mid-Term Results of Treating Kommerell's Diverticulum and Aberrant Subclavian Artery Anomalies Using a Patient-Centered Team Approach. Vasc Endovascular Surg 2023:15385744231154082. [PMID: 36689395 DOI: 10.1177/15385744231154082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The management of Kommerell's Diverticulum (KD) has evolved from open surgical resection and graft replacement of the aorta, to endovascular repair in asymptomatic patients due to its recognized possible sequelae - aortic rupture and dissection. Despite these technical advances, standard indications for intervention and treatment algorithms remain unclear. We will present our single-center experience in the treatment of KD, supporting a multidisciplinary endovascular-first approach. METHODS All patients who underwent thoracic endovascular aortic repair (TEVAR) for KD between 2017 and 2020 were retrospectively identified from a prospectively maintained institutional surgery database. Chart review was used to characterize presenting symptoms, interventions, technical results, and complications. Revascularization was performed using carotid-axillary bypass. Routine endovascular subclavian artery occlusion was employed to eliminate retrograde diverticulum perfusion and avoid open ligation. RESULTS 8 patients were identified, including 6 females and 2 males between the ages of 44-76. Patients presented with dysphagia (n = 3), acute embolic stroke (n = 1), transient ischemic attack (TIA) (n = 1), upper extremity embolization (n = 1), and acute type B aortic dissection (n = 1). One patient had a prior incomplete open repair that was successfully treated endovascularly. Another patient had a mediastinal neoplasm infiltrating an incidental aberrant subclavian artery and KD. All cases had symptomatic improvement and successful endovascular repair as demonstrated on post-operative imaging. Perioperative complications included percutaneous access site pseudoaneurysm (n = 2), stroke (n = 1), and subclavian artery rupture immediately recognized and treated (n = 1). There was no perioperative mortality. CONCLUSION Endovascular techniques have resulted in technical success and symptomatic improvement for KD without open thoracotomy or sternotomy. Significant rates of endovascular complications and paucity of long-term durability data should be considered. Until formal criteria for repair are established, early application of TEVAR using a consistent multi-specialty approach may mitigate the risk of unpredictable aortic complications in these patients while avoiding the accepted morbidity and mortality of open surgery.
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Affiliation(s)
- Dayle K Colpitts
- Department of Surgery, General Surgery, 23146Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - Mecklin V Ragan
- Department of Surgery, General Surgery, 23146Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - David J Spinosa
- Department of Radiology, Vascular and Interventional Radiology, 23146Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - Liam Ryan
- Department of Surgery, Cardiac Surgery, 23146Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - Dipankar Mukherjee
- Department of Surgery, Vascular Surgery, 23146Inova Fairfax Medical Campus, Fairfax, VA, USA
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31
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Zalle I, Zouche ZM, d'Ostrevy N, Pujos CH, Sawadogo A, Chabrot P, Boyer L, Camilleri L. Endovascular Treatment with Arch Vessel Reconstruction on Patients with Kommerell Diverticulum and Aberrant Left Subclavian Artery. J Vasc Interv Radiol 2022; 33:1527-1530. [PMID: 35998802 DOI: 10.1016/j.jvir.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/21/2022] [Accepted: 08/14/2022] [Indexed: 10/15/2022] Open
Abstract
No guidelines for the treatment of Kommerell diverticulum (KD) have been established. Endovascular treatment with arch vessel reconstruction of 4 patients with a right-sided aortic arch and aberrant left subclavian artery are presented herein. A 39-year-old woman and 47-year-old man experienced dyspnea and retrosternal pain. The first patient concomitantly underwent left subclavian transposition and thoracic endovascular aortic repair (TEVAR). The second patient underwent bilateral carotid-subclavian bypass grafting, followed by TEVAR and KD embolization. The 2 other patients were 72- and 75-year old men who presented with KD and type B dissection, in which these conditions were characterized by acute thoracic pain in the former patient and were noted on incidental body scan for prostatic adenocarcinoma in the latter. The third patient underwent carotid-subclavian bypass grafting, followed by TEVAR and subclavian plugs, and in the fourth patient, regular follow-up with antihypertensive therapy was scheduled. After a mean follow-up period of 12 months, all patients were alive.
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Affiliation(s)
- Issaka Zalle
- Department of Cardiac Surgery, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Zied M Zouche
- Department of Radiology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Nicolas d'Ostrevy
- Department of Cardiac Surgery, Gabriel Montpied University Hospital, Clermont-Ferrand, France; ISIT UMR 6284 CNRS, Faculté de médecine, Université d'Auvergne, Clermont-Ferrand, France
| | - Charline H Pujos
- Department of Cardiac Surgery, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Adama Sawadogo
- Department of Cardiac Surgery, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Pascal Chabrot
- Department of Radiology, Gabriel Montpied University Hospital, Clermont-Ferrand, France; ISIT UMR 6284 CNRS, Faculté de médecine, Université d'Auvergne, Clermont-Ferrand, France
| | - Louis Boyer
- Department of Radiology, Gabriel Montpied University Hospital, Clermont-Ferrand, France; ISIT UMR 6284 CNRS, Faculté de médecine, Université d'Auvergne, Clermont-Ferrand, France
| | - Lionel Camilleri
- Department of Cardiac Surgery, Gabriel Montpied University Hospital, Clermont-Ferrand, France; ISIT UMR 6284 CNRS, Faculté de médecine, Université d'Auvergne, Clermont-Ferrand, France.
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32
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Chand S, Babayale O, Rai D, Thapa S, Shah S, Depta JP, Baibhav B. Right aortic arch with common origin of right carotid and left innominate artery: A case report. Clin Case Rep 2022; 10:e6532. [PMID: 36381045 PMCID: PMC9647327 DOI: 10.1002/ccr3.6532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/27/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022] Open
Abstract
Aortic arch anomalies are rare congenital malformations with an incidence of approximately 1-3%. Right aortic arch is an anatomical variant with an incidence of <0.1% associated with various congenital heart diseases. We present a case of a 26-year-old female patient with a right aortic arch with a common origin of right carotid and left innominate artery.
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Affiliation(s)
- Swati Chand
- Rochester General HospitalRochesterNew YorkUSA
| | | | - Devesh Rai
- Rochester General HospitalRochesterNew YorkUSA
| | | | - Sangam Shah
- Institute of MedicineTribhuvan UniversityKathmanduNepal
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Al-Khazaali YM, Hummadi NA, Ismail M, Al-Waely NK, Ahmed FO, Hoz SS, Andaluz N. Right-sided aortic arch with complex anomalies presented with transient ischemic attack. Surg Neurol Int 2022; 13:493. [DOI: 10.25259/sni_913_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
The right-sided aortic arch (RAA) is an uncommon anatomical anomaly found in <0.1% of the adult population. In this article, we report a case of RAA anomaly with an aberrant left subclavian artery (ALSA) and Kommerell’s diverticulum associated with aneurysmal dilation of the ascending aorta, left carotid artery (CCA) stenosis, and pancake kidney presented with a transient ischemic attack (TIA). To the best of our knowledge, this is the first case in the literature that discusses such associations, especially in a symptomatic patient with neurological rather than tracheaesophageal symptoms and in the absence of the steal phenomenon.
Case Description:
A 52-year-old male, with a history of recurrent multiple TIAs, presented immediately after the onset of blurred vision and left-sided weakness. The initial diagnostic cerebral angiogram revealed a left CCA stenosis of <30%, with normal posterior circulation vasculature. The diagnosis of RAA was made with computed tomography angiography (CTA) of the thoracic and abdominal aorta, which revealed Type 2 RAA, with ALSA, which had a bullous dilatation at its origin that suggests Kommerell’s diverticulum. Another two findings on CTA were a persistent left-sided superior vena cava that ended in the coronary sinus and a single pelvic fused renal mass (Pancake kidney).
Conclusion:
We presented an extremely rare case of RAA with ALSA associated with a group of extra rare anomalies. Understanding the anatomical variants of RAA and its characteristics is critical to improving the management and follow-up of patients with such anomalies.
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Affiliation(s)
- Younus M. Al-Khazaali
- Department of Neurosurgery, University of Al-Nahrain, College of Medicine, Bagdad, Iraq,
| | - Noor A. Hummadi
- Department of Radiology, University of Al-Nahrain, College of Medicine, Bagdad, Iraq,
| | - Mustafa Ismail
- Department of Neurosurgery, University of Baghdad, College of Medicine, Bagdad, Iraq,
| | - Noor K. Al-Waely
- Department of Surgery, Al-Nahrain University, College of Medicine, Bagdad, Iraq,
| | - Fatimah O. Ahmed
- Department of Neurosurgery, University of Al-Mustansiriyah, College of Medicine, Bagdad, Iraq,
| | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
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Tiwari KK, Shafiu M, Eleena A, Razzag DA, Niyaf A, Bamne S, Anderson RH. Persistent Patent Arterial Duct Rather Than a Ligament in the Setting of Diverticulum of Kommerell. JACC Case Rep 2022; 4:1370-1374. [PMID: 36299657 PMCID: PMC9588450 DOI: 10.1016/j.jaccas.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/15/2022] [Indexed: 11/19/2022]
Abstract
We report a rare case of persistent patent arterial duct (PDA) in the combination of diverticulum of Kommerell, aberrant left subclavian artery, and total anomalous pulmonary venous connection (TAPVC). Surgical correction of the defect was done by ligating and dividing the PDA and correcting the TAPVC. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Kaushal Kishore Tiwari
- Department of Cardiothoracic and Vascular Surgery, College of Medical Sciences, Bharatpur, Chitwan, Nepal,Department of Cardiothoracic and Vascular Surgery, ADK Hospital, Malé, Maldives,Address for correspondence: Dr Kaushal Tiwari, Department of Cardiothoracic and Vascular surgery, ADK Hospital, Sosun Magu, Malé 20040, Maldives. @drkaushalkt
| | - Mohamed Shafiu
- Department of Cardiothoracic and Vascular Surgery, ADK Hospital, Malé, Maldives
| | - Aishath Eleena
- Department of Pediatrics, ADK Hospital, Malé, Maldives,Department of Pediatric Cardiology, National Cardiac Center, Indira Gandhi Memorial Hospital, Malé, Maldives
| | | | - Abdulla Niyaf
- Department of Pediatrics, ADK Hospital, Malé, Maldives
| | - Sujit Bamne
- Department of Cardiothoracic and Vascular Surgery, ADK Hospital, Malé, Maldives
| | - Robert H. Anderson
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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Ben Ahmed S, Settembre N, Touma J, Brouat A, Favre JP, Jean Baptiste E, Chaufour X, Rosset E. Outcomes in the treatment of aberrant subclavian arteries using the hybrid approach. Interact Cardiovasc Thorac Surg 2022; 35:ivac230. [PMID: 36179094 PMCID: PMC9550270 DOI: 10.1093/icvts/ivac230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/13/2022] [Accepted: 09/29/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Aberrant subclavian artery (ASCA) occurs rarely but is one of the most frequent anatomical variations of the supra-aortic trunks. No consensus has been established on its best treatment. The goal of this study was to report the outcomes of ASCA treated by the hybrid approach. METHODS This non-interventional retrospective multicentre analysis included patients treated for ASCA by the hybrid approach in 12 French university hospitals between 2007 and 2019. The hybrid approach was defined as an endovascular procedure combined with open surgery or a hybrid stent graft. Patients were divided in 4 groups (from less to more complex treatment). The primary end point was 30-day mortality. The secondary end points were 30-day complications and late mortality. RESULTS This study included 43 patients. The mean age was 65 (SD, standard deviation: 16) years. Symptoms were found in 33 patients. Subclavian revascularization combined with aberrant subclavian artery occlusion was undertaken in 13 patients. Unilateral and bilateral subclavian revascularization combined with a thoracic aortic stent graft was undertaken in 11 and 6 patients, respectively. Total aortic arch repair combined with a thoracic aortic stent graft was undertaken in 13 patients. Thirty-day mortality was 2.3% with a technical success rate of 95.3%. The 30-day major postoperative complication rate was 16.3%: 4 strokes, 2 tamponades, 1 acute respiratory distress syndrome. Mean follow-up was 56.3 (SD: 44.7) months. The late mortality was 18.6%. CONCLUSIONS The ASCA hybrid approach is feasible, safe and effective with low early mortality. Morbidity is rather high. However, it increases with the complexity of the hybrid approach, which should be kept as simple as possible if the anatomical morphology allows.
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Affiliation(s)
- Sabrina Ben Ahmed
- Service de Chirurgie Vasculaire et Cardiovasculaire, CHU Saint-Etienne, Saint-Etienne, France
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France
| | - Nicla Settembre
- Service de Chirurgie Vasculaire, CHU Nancy, Université de Lorraine, Nancy, France
| | - Joseph Touma
- Service de Chirurgie Vasculaire, CHU Henri Mondor, AP-HP, Créteil, France
| | - Anthony Brouat
- Service de Chirurgie Vasculaire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Pierre Favre
- Service de Chirurgie Vasculaire et Cardiovasculaire, CHU Saint-Etienne, Saint-Etienne, France
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France
| | | | - Xavier Chaufour
- Service de Chirurgie Vasculaire, CHU Toulouse, Toulouse, France
| | - Eugenio Rosset
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France
- Centre Cardio-Thoracique de Monaco, Monaco
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36
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Kakucs Z, Heidenhoffer E, Pop M. Detection of Coronary Artery and Aortic Arch Anomalies in Patients with Tetralogy of Fallot Using CT Angiography. J Clin Med 2022; 11:jcm11195500. [PMID: 36233367 PMCID: PMC9570993 DOI: 10.3390/jcm11195500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/17/2022] [Accepted: 09/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease (CHD). Furthermore, the prevalence of anomalous origin of a coronary artery is higher in patients with TOF than in the general population (6% vs. ≤1%). Preoperative assessment of cardiovascular anatomy using computed tomography (CT) angiography enables the adaptation of the surgical approach to avoid potentially overlooked anomalies. Our purpose was to determine the prevalence of coronary artery and aortic arch anomalies in a cohort of TOF patients. Methods: In this retrospective analysis, data were collected from CT reports (2015–2021) of 105 TOF patients. All images were acquired using a 64-slice multi-detector CT (MDCT) scanner. Results: The median age of the patients was 38.7 months, with a male-to-female ratio of 1.39. The overall prevalence of coronary artery anomalies (CAAs) was 7.61% (8 of 105 cases). The anomalous origin and course of coronary arteries across the right ventricular outflow tract (RVOT; prepulmonic course) were defined in 5.71% of cases (six patients). In four of these, the left anterior descending artery (LAD) originated from the right coronary artery (RCA), while in two cases, the RCA arose from the LAD. In the remaining two patients, the coronary arteries followed an interarterial course. The most frequent anomalous aortic arch pattern in the overall TOF population was the right aortic arch (RAA) with mirror image branching, seen in 20% of patients (21 cases). The most frequent anomaly of the supra-aortic trunks was bovine configuration, found in 17.14% (18 cases). Conclusions: The prevalence of CAAs and aortic arch anomalies detected by CT angiography was in line with the data reported in anatomical specimens. Therefore, this technique represents a powerful tool for the evaluation of congenital cardiovascular anomalies.
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Affiliation(s)
- Zsófia Kakucs
- Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania
- Correspondence: (Z.K.); (E.H.)
| | - Erhard Heidenhoffer
- Clinical County Hospital Mures, 540103 Targu Mures, Romania
- Correspondence: (Z.K.); (E.H.)
| | - Marian Pop
- ME1 Department, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
- Emergency Institute for Cardiovascular Disease and Transplant of Targu Mures, 540136 Targu Mures, Romania
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37
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Root of the Neck and Extracranial Vessel Anatomy. Neuroimaging Clin N Am 2022; 32:851-873. [DOI: 10.1016/j.nic.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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38
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Lin R, Jiang R, Wang S, Zheng J, Sun Y, Xue Y, Huang X. Alterations of Arterial Morphology in Aberrant Subclavian Artery Patients with Type B Dissection and its Association with Dissection. J Vasc Surg 2022; 76:891-898.e2. [PMID: 35753651 DOI: 10.1016/j.jvs.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/13/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The arterial morphology in aberrant subclavian artery (ASA) patients and its association with type B aortic dissection are important for treatment and prevention. This study examined the arterial morphology of ASA patients with type B dissection and evaluated its association with type B dissection in vivo. METHODS The presence of ASA and type B dissection was screened from patients with aortic dissection receiving computed tomography angiography (CTA) from January 2011 to May 2021. ASA patients with type B dissection (Group 1, n=16), clinically-matched counterparts without type B dissection (Group 2, n=32) and clinically-matched type B dissection subjects without ASA (Group 3, n=32) were measured for the angles of ascending aorta, aortic arch, aortic deviation, and the diameters of ascending aorta, aortic arch, ASA ostium and middle ASA segment. The correlation between ASA morphology and type B dissection was analyzed by variance analysis or Wallies H test. RESULTS Compared with Group 2, Group 1 reported a sharper ascending aortic angle (131.5o±13.7o vs. 148.1o±7.8o, P=0.001), larger aortic deviation angle in plane 2 (28.2o±6.0o vs. 22.1o±7.2o, P=0.005) and plane 3 (26.4 o±7.3o vs. 21.8o±6.3o, P=0.028). Similarly, Group 1 displayed a greater diameter in the ascending aorta, aortic arch, and the ostium and middle of ASA (38.3±4.1mm vs. 33.6±4.5mm, P=0.001; 34.0±9.3mm vs. 26.2±2.9mm, P=0.004; 20.3±9.3mm vs. 14.0±3.2mm, P=0.018; 10.8±2.3mm vs. 9.0±1.5mm, P=0.002, respectively), without a significant difference in the aortic arch angle. Compared with Group 3, Group 1 showed a sharper ascending aortic angle (131.5o±13.7o vs. 142.5o±11.7o, P=0.026) and smaller aortic deviation angle in plane 1 (21.7o±6.2o vs. 28.9o±6.2o, P=0.04) and plane 3 (26.4o±7.3o vs. 21.8o±6.3o, P=0.007), though with no significant difference in the aortic arch angle, aortic deviation angle in plane 2, and ascending aortic diameter. CONCLUSIONS The diameters of the ostium and middle segment of ASA and ascending aorta and the angles of ascending aorta and aortic deviation are potential risk factors for type B dissection in ASA patients, which may provide new insights into the mechanism of type B dissection in patients with ASA.
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Affiliation(s)
- Ruolan Lin
- Department of Radiology, Fujian Medical University Union Hospital, Fujian, China
| | - Rifeng Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fujian, China
| | - Shu Wang
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou 350108, China
| | - Jinmei Zheng
- Department of Radiology, Fujian Medical University Union Hospital, Fujian, China
| | - Yifan Sun
- Department of Radiology, Fujian Medical University Union Hospital, Fujian, China
| | - Yunjing Xue
- Department of Radiology, Fujian Medical University Union Hospital, Fujian, China.
| | - Xinming Huang
- Department of Radiology, Fujian Medical University Union Hospital, Fujian, China.
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Gupta T, Jamaleddine N, McFarlane SI. Arteria Lusoria With Right-Sided Aortic Arch and Atrial Septal Defect Associated With Extensive Thrombosis and Paradoxical Embolism: A Case Report. Cureus 2022; 14:e26173. [PMID: 35891839 PMCID: PMC9303096 DOI: 10.7759/cureus.26173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/26/2022] Open
Abstract
In this report, we present an incidental finding of a rare combination of an Aberrant Right Subclavian Artery (ARSA), or arteria lusoria, with right-sided aortic arch and atrial septal defect associated with extensive thrombosis and paradoxical embolism causing acute stroke in an octogenarian woman with COPD presenting with acute hypercapnic respiratory failure. We also discuss the various surgical approaches for management and conservative treatment alternatives in non-surgical candidates (as in this case). We believe that this is the first reported case of these combined rare anomalies in an asymptomatic patient to the best of our knowledge.
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40
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Marchenko AV, Myalyuk PA, Kadyraliev BK, Musaev OG, Lilothia SH, Vronsky AS, Khramtsov VS, Enginoev ST, Arutyunyan VB, Sinelnikov YS. Surgical treatment of Kommerell's diverticulum. J Card Surg 2022; 37:2873-2878. [PMID: 35665965 DOI: 10.1111/jocs.16646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
Kommerell's diverticulum (KD) is a rare congenital vascular abnormality due to the formation of an abnormal aortic arch, most commonly associated with dilatation at the proximal part of the aberrant subclavian artery. This article describes an option of surgical treatment in a patient with KD. The proposed new technique of aortic arch surgical reconstruction with a stent-graft placement in the descending aorta reduces CPB time, aortic clamp and circulatory arrest time.
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Affiliation(s)
- Andrey V Marchenko
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Pavel A Myalyuk
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Bakytbek K Kadyraliev
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Orkhan G Musaev
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Sophia H Lilothia
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Alexey S Vronsky
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Vitaliy S Khramtsov
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Soslan T Enginoev
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery" of the Ministry of Health of the Russian Federation, Astrakhan, Astrakhan Region, Russian Federation.,Federal State Budgetary Educational Institution of Higher Education "Astrakhan State Medical University" of the Ministry of Health of the Russian Federation, Astrakhan, Astrakhan Region, Russian Federation
| | - Vagram B Arutyunyan
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
| | - Yuriy S Sinelnikov
- Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation, Perm, Perm Region, Russian Federation
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Alie-Cusson FS, Mesar T, Abou-Assi S, Rathore A, Panneton JM. Left internal mammary artery access for embolization of the left subclavian artery in a patient with type II endoleak after thoracic endovascular aortic repair for a ruptured right-sided aortic arch aneurysm. J Vasc Surg Cases Innov Tech 2022; 8:175-178. [PMID: 35391996 PMCID: PMC8980532 DOI: 10.1016/j.jvscit.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/31/2022] [Indexed: 11/11/2022] Open
Abstract
A 65-year-old woman had presented with a ruptured type B intramural hematoma associated with a right-sided aortic arch aneurysm, a large Kommerell diverticulum (KD) and an aberrant left subclavian artery (LSA). She underwent total aortic arch replacement with elephant trunk, thoracic endovascular aortic repair, and LSA ligation distal to the left vertebral artery. She subsequently developed a brisk type II endoleak into the KD via retrograde flow from the left vertebral artery. Percutaneous access of the left internal mammary artery with coil embolization of the proximal LSA and KD was performed. At 5 years, computed tomography angiogram showed complete thoracic aortic remodeling without an endoleak. The results from the present case have illustrated the novel use of the left internal mammary artery as an alternative access for LSA embolization in patients with type II endoleak and limited access options.
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Konishi Y, Tatsuishi W, Shibuya K, Konno N, Abe T. Hybrid repair of a distal aortic arch aneurysm with aberrant right subclavian artery and Kommerell's diverticulum: A case report. Int J Surg Case Rep 2022. [PMCID: PMC9168116 DOI: 10.1016/j.ijscr.2022.107172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction and importance Aberrant right subclavian artery (ARSA) and Kommerell's diverticulum (KD) are common vascular anomalies of the aortic arch. Anatomic reconstruction of ARSA is difficult with only the median sternotomy approach. Case presentation A 55-year-old woman was referred to our hospital for a thoracic aneurysm. CT showed 46 mm diameter of distal aortic arch aneurysm with ARSA and KD. ARSA branched from the distal aortic arch and crossed behind the esophagus. It was difficult to reconstruct ARSA anatomically via the median sternotomy approach. We performed coil embolization of ARSA and total aortic arch replacement (TAR) and extra-anatomic right subclavian artery reconstruction for the distal aortic arch aneurysm with ARSA and KD. The patient was discharged home with no complications. Clinical discussion There were differences in blood pressure of the upper extremities after coil embolization of ARSA; however, subclavian steal syndrome or cerebral complications did not occur. If there is no abnormal finding in head and neck arteries before surgery, coil embolization of ARSA is safe and open distal anastomosis of the distal aortic arch can be performed in a bloodless field. Conclusion Hybrid repair by coil embolization and TAR for the distal aortic arch aneurysm with ARSA and KD were considered to be a useful in the absence of cerebral vascular stenosis or obstruction.
Anatomic reconstruction of aortic arch anomaly with aortic aneurysm is difficult. Hybrid repair by coil embolization and open surgery is useful and safe.
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Chourda E, Putotto C, Versacci P, Saltarocchi S, D'Abramo M, Tshomba Y, Tinelli G, Miraldi F. Hybrid Single-Stage Repair of Kommerell's Diverticulum in a Right Aortic Arch in a Patient With 22q11.2 Deletion Syndrome. Vasc Endovascular Surg 2022; 56:595-601. [PMID: 35442127 DOI: 10.1177/15385744221090911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hybrid single-stage repair of Kommerell's diverticulum in a right aortic arch.Aortic arch anomalies, isolated or associated with congenital heart defects, are cardiovascular manifestations frequently associated with 22q11.2 deletion syndrome. Kommerell's diverticulum in the context of a right aortic arch is an exceedingly rare congenital anomaly, consisting in aneurysmal degeneration of the origin of an aberrant left subclavian artery. Open surgical repair has been the treatment paradigm, but in recent years, hybrid and endovascular procedures have also been proposed. In this report we present the case of a patient affected by 22q11.2 deletion syndrome successfully treated for Kommerell's diverticulum associated with a right-sided aortic arch through a single-stage hybrid procedure, consisting of bilateral carotid-subclavian bypass, exclusion of the diverticulum by an endovascular thoracic stent graft, and aberrant left subclavian artery plug occlusion. This type of hybrid technique can be an excellent alternative to extensive open surgical repairs or when total endovascular repair is deemed unachievable, also in the context of a complex genetic syndrome.
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Affiliation(s)
- Emmanouela Chourda
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Carolina Putotto
- Department of Pediatrics, Obstetrics and Gynecology, 9311Sapienza University of Rome, Rome, Italy
| | - Paolo Versacci
- Department of Pediatrics, Obstetrics and Gynecology, 9311Sapienza University of Rome, Rome, Italy
| | - Sara Saltarocchi
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Mizar D'Abramo
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 96983Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 96983Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
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Konami Y, Sakamoto T, Horio E, Suzuyama H, Taguchi E, Sassa T, Ideta I, Yamada M, Horibata Y, Nakao K. Transfemoral transcatheter aortic valve implantation by three-dimensional computed tomography/fluoroscopy fusion imaging guidance in a patient with right-sided aortic arch and chronic aortic dissection. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 40S:179-181. [DOI: 10.1016/j.carrev.2022.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 11/03/2022]
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Cho JS. Unraveling the enigma of an aberrant subclavian artery (arteria lusoria). J Vasc Surg 2022; 75:1349-1350. [PMID: 35314040 DOI: 10.1016/j.jvs.2021.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/28/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Salem R, Anantharajah L, Hecker F, Nour-Eldin NEA, Hlavicka J, Walther T, Holubec T. Minimally Invasive Treatment of Kommerell's Diverticulum and Left Aberrant Subclavian Artery. Ann Thorac Surg 2022; 114:e313-e315. [PMID: 35216988 DOI: 10.1016/j.athoracsur.2022.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 11/19/2022]
Abstract
Kommerell's diverticulum is an aneurysmatic off-spring of the left aberrant subclavian artery, which is a rare vascular anomaly of the aortic arch. Here, we present our less invasive approach to the repair of a symptomatic Kommerell's diverticulum in a 31-year-old patient, without the use of cardio-pulmonary bypass.
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Affiliation(s)
- Razan Salem
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany
| | - Luxia Anantharajah
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany
| | - Florian Hecker
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany
| | - Nour Eldin A Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany; Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt
| | - Jan Hlavicka
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany
| | - Thomas Walther
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany
| | - Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt, Germany.
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Systematic review and meta-analysis of outcomes after operative treatment of aberrant subclavian artery pathologies and suggested reporting items. Eur J Vasc Endovasc Surg 2022; 63:759-767. [DOI: 10.1016/j.ejvs.2022.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 01/31/2022] [Accepted: 02/20/2022] [Indexed: 11/17/2022]
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Single-stage repair of the right aortic arch with Kommerell diverticulum through the right thoracotomy with SIRC approach. Gen Thorac Cardiovasc Surg 2022; 70:498-500. [DOI: 10.1007/s11748-022-01781-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022]
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49
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Topbas Selcuki NF, Senol G, Esin D, Ozkose ZG, Caypinar SS, Bornaun H, Cetin BA, Yuksel MA. Prenatal diagnosis and postnatal outcomes of right aortic arch anomalies. Arch Gynecol Obstet 2022; 306:745-752. [PMID: 34981204 DOI: 10.1007/s00404-021-06346-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 11/22/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE To give a report on the experience of our tertiary perinatology clinic on the pre- and postnatal management of the right aortic arch (RAA) by evaluating the patients as isolated and non-isolated RAA. MATERIALS AND METHODS Patients referred to our perinatology clinic for fetal echocardiography were evaluated retrospectively. They were assessed in two groups: isolated RAA and non-isolated RAA. The isolated RAA group consisted of patients without any additional cardiac or extracardiac anomalies. According to our routine practice, all patients received detailed prenatal ultrasonography following fetal echocardiography and genetic counseling. RESULTS A total of 60 patients were evaluated. 38 patients (63.3%) presented with additional cardiac anomalies. 21.7% had extracardiac anomalies, including 16.7% who also had cardiac anomalies. In 2 patients (3.7%) 22q11.2 microdeletion, in 2 patients (3.7%) trisomy 21, in 1 patient (1.9%) trisomy 13 and in 1 patient (1.9%) 20p12.1p11.23 (a deletion of 2880 kbp) were reported. The most common cardiac anomaly associated with RAA was Tetralogy of Fallot (25%). Fetal growth restriction was reported in 8.3% of the cases. 18 patients had isolated RAA. 16 out of the 18 patients had normal genetic analysis. 2 of them (11.11%) presented with a 22q11.2 microdeletion. CONCLUSION A single-center experience on the diagnosis and management of RAA has been reported in this study. The results indicate that a prenatal cardiac evaluation in 3VV is of utmost importance in all pregnancies to detect RAA and refer these patients to the appropriate perinatology clinics for further evaluation and care.
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Affiliation(s)
- Nura Fitnat Topbas Selcuki
- Department of Obstetrics and Gynecology, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Kazim Karabekir Pasa, Bahcekoy Cd. No:64 D:64, 34453, Sariyer, Turkey.
| | - Gokalp Senol
- Department of Obstetrics and Gynecology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Didem Esin
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Zeynep Gedik Ozkose
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Sema Suzen Caypinar
- Department of Perinatology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Helen Bornaun
- Department of Pediatric Cardiology, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Berna Arslan Cetin
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Mehmet Aytac Yuksel
- Department of Obstetrics and Gynecology, Beykent University, Istanbul, Turkey
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Nakamura Y, Kumada Y, Mori A, Kawai N, Ishida N, Kasugai T. Thoracic endovascular aortic repair for chronic aortic dissection after total arch replacement for aberrant right subclavian artery: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221123432. [PMID: 36119664 PMCID: PMC9478695 DOI: 10.1177/2050313x221123432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
An aberrant right subclavian artery (ARSA) is an extremely rare congenital anomaly that forms during aortic arch development. Most reports of thoracic endovascular aortic repair (TEVAR) described an ARSA in the right aortic arch, but it is rare in the left aortic arch. We present the case of a 66-year-old man who underwent total arch replacement because of acute type A aortic dissection. An outpatient follow-up examination revealed that the aortic diameter enlargement exceeded 60 mm because of false lumen entry from the ARSA. Therefore, surgical intervention was planned. TEVAR, ARSA embolization, and bilateral axillary bypass surgery were successfully performed for a chronic dissecting aortic aneurysm for which the ARSA was the inflow route. He was discharged 12 days after surgery. Four years later, no enlargement of the aneurysm diameter was observed. TEVAR is a minimally invasive and useful treatment option for chronic type B dissections with an ARSA associated with the left aortic arch; however, patients with an ARSA have fragile blood vessels and require careful follow-up.
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Affiliation(s)
- Yasuhito Nakamura
- Department of Cardiovascular Surgery, Matsunami General Hospital, Gifu, Japan
| | - Yoshitaka Kumada
- Department of Cardiovascular Surgery, Matsunami General Hospital, Gifu, Japan
| | - Akihiro Mori
- Department of Cardiovascular Surgery, Matsunami General Hospital, Gifu, Japan
| | - Norikazu Kawai
- Department of Cardiovascular Surgery, Matsunami General Hospital, Gifu, Japan
| | - Narihiro Ishida
- Department of Cardiovascular Surgery, Matsunami General Hospital, Gifu, Japan
| | - Toshio Kasugai
- Department of Chest Surgery, Matsunami General Hospital, Gifu, Japan
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