Surgical Treatment for Kommerell Diverticulm

(Department of Thoracic and Cardiovascular Surgery, Osaka Medical College Hospital, Takatsuki, Japan)

Shigetoshi Mieno Hideki Ozawa Masahiro Daimon
Tomoyasu Sasaki Eiki Woo Takahiro Katsumata
We report 3 surgical cases of aortic graft replacement with reconstruction of an aberrant subclavian artery(ASA)for Kommerell diverticulum(KD)and ASA. Cases 1 and 2 both had a right aortic arch, KD and a left ASA. In these 2 cases, we performed distal aortic arch replacement and in-situ reconstruction of the left ASA via a right thoracotomy. Case 3 had an aortic arch aneurysm, KD and a right ASA. In this patient, we chose median sternotomy and total aortic arch replacement, using 2 pieces of artificial grafts with 1 and 4 branches, respectively. The right ASA was reconstructed by end-to-side anastomosis between the right axillary artery and the side branch of the graft with 1 branch. In all 3 cases, cardiopulmonary bypass and deep hypothermia with a rectal temperature under 18℃ were used in aortic graft replacement. In addition to deep hypothermia, either antegrade or retrograde cerebral perfusion was introduced, depending on the surgical situation, to provide additional brain protection. Selective ASA perfusion was performed in all patients during aortic graft replacement. In Case 1, aortic anastomosis was achieved while clamping, and cerebral perfusion was maintained via a cannula for aortic return at the ascending aorta. In Cases 2 and 3, aortic anastomosis was performed under deep hypothermic circulatory arrest, using retrograde and antegrade cerebral perfusion respectively in Cases 2 and 3. The postoperative course was uneventful in all 3 patients.
  Jpn. J. Cardiovasc. Surg. 40:144-149(2011)

Keywords:aortic surgery, Kommerell diverticulum, aberrant subclavian artery