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Surgical treatment of an aneurysm in the right aortic arch with aberrant left subclavian artery

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Abstract

A saccular aneurysm in the right-sided aortic arch with aberrant left subclavian artery is an uncommon disease, and surgical treatment is complicated. Three patients with Edwards type III-B right aortic arch and enlargement of the Kommerell’s diverticulum underwent operations. Right thoracotomy was the preferred approach for this lesion and partial cardiopulmonary bypass is a safe and simple procedure when the aortic arch has mild atherosclerosis.

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

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There are more references available in the full text version of this article.

Cited by (46)

  • Hybrid Approach to a Right Aortic Arch With a Large Kommerell's Diverticulum

    2021, Annals of Thoracic Surgery
    Citation 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 Surgery
    Citation 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.

  • Kommerell’s diverticulum: A rare aortic arch anomaly

    2016, Medical Journal Armed Forces India
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