Limited dissection in Kommerell diverticulum of aberrant right subclavian artery

Aberrant right subclavian artery is a rare anatomical finding of abnormal embryologic development of the dorsal aorta and right subclavian artery. An associated aortic outpouching, or Kommerell diverticulum, may develop at the origin of the aberrant right subclavian artery. Given historically high rates of aneurysm rupture and mortality, early repair is indicated. Successful aneurysm exclusion can be accomplished with thoracic endovascular stent grafting following open carotid-subclavian bypass, maintaining upper extremities perfusion. Such hybrid techniques offer a decrease in mortality and complication rates. Herein, we describe a successful repair of a symptomatic (dysphagia, weight loss) aberrant right subclavian artery with Kommerell diverticulum using this hybrid open-endovascular approach.

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Hybrid repair of aberrant right subclavian artery with aortic dissection caused by Kommerell diverticulum

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02340-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tieyan Li ◽

Lin Zou ◽

Yunzhen Feng ◽

Guoliang Fan ◽

Yuanfeng Xin

Keyword(s):

Subclavian Artery ◽

Treatment Options ◽

Aortic Disease ◽

Aberrant Right Subclavian Artery ◽

Stent Grafting ◽

Hybrid Operation ◽

Adjacent Structures ◽

Risk Of Rupture ◽

Hybrid Repair ◽

Kommerell Diverticulum

Abstract Background Aberrant right subclavian artery (ARSA) with associated Kommerell diverticulum (KD) is a rare congenital aortic disease. KD patients have a high risk of rupture, dissection, and compression of adjacent structures. Although several treatment options have been proposed (traditional surgery, hybrid operation, and endovascular intervention), a consensus regarding optimal surgical management has not yet been established. Case presentation A case of successful hybrid repair of distal aortic arch dissection aneurysm by dissecting KD and ARSA with debranching of right and left common carotid arteries, left subclavian artery, and stent grafting was presented. Conclusions The hybrid operation is suitable for elderly patients or those with high risks. Along with intervention, the hybrid operation needs to be developed as a minimally invasive method.

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Study on the views and methods of ultrasonic screening and diagnosis for abnormal aortic arch in infants

Cardiovascular Ultrasound ◽

10.1186/s12947-021-00237-2 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Xinjian He ◽

Jiaoyang Chen ◽

Gaoyang Li

Keyword(s):

Diagnostic Accuracy ◽

Aortic Arch ◽

Subclavian Artery ◽

Coarctation Of The Aorta ◽

Double Aortic Arch ◽

Aberrant Right Subclavian Artery ◽

Coincidence Rate ◽

Aortic Arch Anomalies ◽

Screening Sensitivity ◽

Axis View

Abstract Background The purpose of this study was to explore echocardiographic views and methods of aortic arch anomalies in infants, so as to improve the screening sensitivity and diagnostic accuracy. Methods 140 children with abnormal aortic arch diagnosed by ultrasound in Children’s Hospital of Hebei Province from January 2014 to December 2019 were selected for retrospective analysis. All were confirmed by surgery or/and computerized tomography angiography. Series of views for aortic arch (the three-vessel and tracheal view, aortic arch short axis view, left aortic arch long axis view, aortic arch long axis continuous scan views) were performed in all cases on the basis of the routine views of echocardiography. The screening sensitivity and diagnostic coincidence rate of different echocardiographic views for aortic arch anomalies were analyzed. Results Among the 140 infants, right aortic arch were 21 cases (6/21 were accompanied by mirror branch and 15/21 were with aberrant left subclavian artery). Left aortic arch with aberrant right subclavian artery were 2 cases, and double aortic arch with both arches open were 20 cases. Double aortic arch with left arch atresia were 2 cases, and atresia of the proximal aorta with aortic arch dysplasia was 1 case. Coarctation of the aorta were 67 cases, and interruption of aortic arch were 27 cases. All the patients were correctly diagnosed except that 2 infants with interruption of aortic arch were incorrectly diagnosed as coarctation of the aorta, and 1 infant with coarctation of the aorta was misdiagnosed as interruption of aortic arch by echocardiography. The screening sensitivities of four views and four-view combination for abnormal aortic arch were 99.3, 73.6, 87.1, 99.3, and 100%; the diagnostic coincidence rates were 85.7, 27.1,66.4, 95.0%, and 97.9% respectively. On the basis of traditional left aortic long axis view, other three views had their own advantages. The screening sensitivity and diagnostic coincidence rate of four-view combination were significantly improved. Conclusions The three-vessel trachea view is simple and feasible, which is suitable for screening abnormal aortic arch. The combination of four views conduces to improving screening sensitivity and diagnostic accuracy of aortic arch abnormalities.

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Case report: a step-wise management of concurrent presentation of congenital single lung and aberrant right subclavian artery in an infant girl

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01520-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Keon Young Park ◽

Kevin C. Janek ◽

Joshua L. Hermsen ◽

Petros V. Anagnostopoulos ◽

Hau D. Le

Keyword(s):

Subclavian Artery ◽

Tissue Expander ◽

Rare Condition ◽

Aberrant Right Subclavian Artery ◽

Cross Sectional ◽

Unique Challenge ◽

Surgical Interventions ◽

Tracheal Compression ◽

Dysphagia Lusoria ◽

Infant Girl

Abstract Introduction Congenital single lung (CSL) is a rare condition, and symptomatic patients often present with respiratory distress or recurrent respiratory infection due to mediastinal shift causing vascular or airway compression. Aberrant right subclavian artery (ARSA) is another rare congenital anomality that can lead to tracheal or esophageal compressions. There is only one other case of concurrent presentation of CSL and ARSA reported, which presented unique challenge in surgical management of our patient. Here we present a step-wise, multidisciplinary approach to manage symptomatic CSL and ARSA. Case presentation An infant girl with a prenatal diagnosis of CSL developed worsening stridor and several episodes of respiratory illnesses at 11 months old. Cross-sectional imaging and bronchoscopic evaluation showed moderate to severe distal tracheomalacia with anterior and posterior tracheal compression resulting from severe mediastinal rotation secondary to right-sided CSL. It was determined that her tracheal compression was mainly caused by her aortic arch wrapping around the trachea, with possible additional posterior compression of the esophagus by the ARSA. She first underwent intrathoracic tissue expander placement, which resulted in immediate improvement of tracheal compression. Two days later, she developed symptoms of dysphagia lusoria due to increased posterior compression of her esophagus by the ARSA. She underwent transposition of ARSA to the right common carotid with immediate resolution of dysphagia lusoria. As the patient grew, additional saline was added to the tissue expander due to recurrence in compressive symptoms. Conclusions Concurrent presentation of CSL and ARSA is extremely rare. Asymptomatic CSL and ARSA do not require surgical interventions. However, if symptomatic, it is crucial to involve a multidisciplinary team for surgical planning and to take a step-wise approach as we were able to recognize and address both tracheomalacia and dysphagia lusoria in our patient promptly.

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