Kommerell Diverticulum Should Be Removed in Children With Vascular Ring and Aberrant Left Subclavian Artery.

Abstract

BACKGROUND:

Right aortic arch with aberrant left subclavian artery is the most frequent cause of vascular ring. Ligamentum arteriosus division opens the ring but leaves the Kommerell diverticulum in place, with a risk of residual compression, aneurysmal dilation, dissection, or even rupture. A procedure consisting of translocation of the aberrant left subclavian artery to the left carotid artery with removal of the Kommerell diverticulum and division of the ligamentum is currently advocated.

METHODS:

Between September /2009 and August 2011, 12 consecutive patients underwent the foregoing procedure. Clinical findings, surgical procedure, complications, histopathologic findings, and follow-up data were retrospectively analyzed.

RESULTS:

Mean age at the time of operation was 7.7 years (median, 4.3 years, range, 0.9 to 18.9 years), and mean weight was 26 kg (median, 18 kg; range, 8.4 to 59 kg). All patients had symptoms. Computed tomography scan or magnetic resonance imaging, or both, had confirmed the diagnosis in all patients. Postoperative events, all transient, included chylothorax (1 patient), phrenic palsy (1 patient), pneumonia (1 patient), and the need for prolonged chest drainage (3 patients). Mean follow-up reached 19 months (median, 13 months; range, 12 to 41 months). Mild residual respiratory symptoms were noted in 3 patients. Echo-Doppler analysis showed a patent left subclavian-to-carotid artery anastomosis. Histopathologic analysis of the resected diverticulum (n = 6) showed cystic medial necrosis in four diverticula (focal in one).

CONCLUSIONS:

Translocation of the aberrant left subclavian artery with diverticulum resection and ligamentum division is an efficient procedure for symptom relief. Profound wall abnormalities such as medial necrosis in at least 50% of the analyzed diverticula encourage us to maintain this strategy, to reduce the risk of aneurysm formation and dissection.

• Authors: Deborah Luciano, Julia Mitchell, Alain Fraisse, Hubert Lepidi, Bernard Kreitmann, Caroline Ovaert
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 100 Issue 6 Pg. 2293-7 (Dec 2015) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 26428693 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Aneurysm (diagnosis, surgery)
• Aorta, Thoracic (abnormalities, surgery)
• Aortic Arch Syndromes (diagnosis, surgery)
• Cardiovascular Abnormalities (diagnosis, surgery)
• Child
• Child, Preschool
• Deglutition Disorders (diagnosis, surgery)
• Diverticulum (diagnosis, surgery)
• Echocardiography, Doppler
• Female
• Humans
• Infant
• Magnetic Resonance Imaging
• Male
• Retrospective Studies
• Subclavian Artery (abnormalities, surgery)
• Tomography, X-Ray Computed
• Vascular Surgical Procedures (methods)
• Young Adult