Surgical management of right aortic arch with tailored surgical approach

Total arch replacement with frozen elephant trunk technique for Kommerell's diverticulum with a right-sided aortic arch and aberrant left subclavian artery

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.

Surgical Treatment of Dysphagia Lusoria Caused by Right-Aortic Arch with Kommerell Diverticulum: Left Heart Bypass without Subclavian Revascularization

The authors present the case of a 26-year-old patient suffering from dysphagia because of compression by a Kommerell diverticulum in right aortic arch anomaly. Open surgical arch and descending aorta replacement with left heart bypass without left subclavian artery reimplantation was performed.