How to do itSurgical treatment of an aneurysm in the right aortic arch with aberrant left subclavian artery
Section snippets
Technique
A right thoracotomy through the fourth intercostal space was performed. The right phrenic nerve and the superior vena cava were retracted anteriorly. Distal portion of the right-sided aortic arch was exposed from the origin of the right carotid artery. The right vagus was descending at the anterior portion of the aortic arch (Fig 1A). Right atrial and right femoral arterial cannulation were performed and partial cardiopulmonary bypass (CPB) with mild hypothermia (32°C) was initiated. The
Comment
Right aortic arch with ALSA is an uncommon arch anomaly, occurring in about 0.05% of the population [2]. In this anomaly the first branch arising from the aortic arch is the left carotid artery, followed by the right carotid artery, RSA, and left subclavian artery (in that order) [4]. Aortic aneurysms related to the right aortic arch are even more rare. An aneurysm located at the base of the ALSA, Kommerell’s diverticulum, is well known to cause tracheal compression or dysphagia.
Surgical
References (4)
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Aneurysm of right-sided cervical archsurgical removal and graft replacement
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Congenital abnormalities of the aorta in adults
Cited by (46)
Hybrid Approach to a Right Aortic Arch With a Large Kommerell's Diverticulum
2021, Annals of Thoracic SurgeryCitation Excerpt :Among surgical approaches, resection of the KD via a left thoracotomy allowing lateral clamping of the descending aorta was an option, but the fragility of the aortic wall made lateral suturing high risk. The approach via a right thoracotomy was therefore the preferred technique and allowed good exposure of the whole RAA.6 However, the lower origin of the LVA in this case was going to make it hard to resect or exclude the large ALSA through the right thoracotomy and to control any prospective operative bleeding from its collaterals, so it was therefore decided that preoperative arterial embolization of the LVA and other collaterals would be performed.
Outcomes of Repair of Kommerell Diverticulum
2019, Annals of Thoracic SurgeryCitation Excerpt :In our study, the rate of reported acute aortic rupture in nonsurgical patients was only 1.1%, substantially lower than what is reported in the literature. This could be a result of our lower threshold to operate (average KD size for surgical patients = 3.1 cm), as opposed to other centers that electively repaired diverticula only at sizes closer to 5 cm.17,22 Advanced imaging techniques have also allowed us to monitor and track the progression of the disease more accurately to pursue surgery earlier and mitigate the risk of aortic catastrophe.
Foreign body sensation: A rare case of dysphagia lusoria in a healthy female
2018, American Journal of Emergency MedicineKommerell’s diverticulum: A rare aortic arch anomaly
2016, Medical Journal Armed Forces IndiaEndovascular repair of a right-sided thoracic aortic aneurysm with kommerell diverticulum and aberrant left subclavian artery
2014, Annals of Vascular Surgery