Surgical repair for aortic dissection accompanying a right-sided aortic arch
© Obitsu et al; licensee BioMed Central Ltd. 2010
Received: 23 March 2010
Accepted: 10 May 2010
Published: 10 May 2010
Aortic anomaly in which a right-sided aortic arch associated with Kommerell's diverticulum and aberrant left subclavian artery is rare. The present report describes a patient with type-B aortic dissection accompanying aortic anomalies consisting of right-sided aortic arch and the left common carotid and left subclavian artery arising from Kommerell's diverticulum. As dissecting aortic aneurysm diameter increased rapidly, Single-stage surgical repair of extensive thoracic aorta was performed through median sternotomy and right posterolateral fifth intercostal thoracotomy, yielding favorable results. Our surgical procedures are discussed.
Aortic anomalies in which a right-sided aortic arch is complicated by an aberrant left subclavian artery are rare, with a reported incidence of 0.05% of the population . While many patients are asymptomatic, surgery is indicated when accompanied by Kommerell's diverticulum aneurysm or vascular ring compression. We performed single-stage surgical repair of extensive thoracic aorta for a patient with aortic anomalies consisting of right-sided aortic arch, the left common carotid and left subclavian artery arising from Kommerell's diverticulum and type B aortic dissection, obtaining favorable results. Our surgical procedures are reported herein.
Surgery is not necessarily indicated for Kommerell's diverticulum accompanying aortic anomaly. However, if clinical symptoms are present related to vascular ring, such as respiratory and swallowing impairments, surgery is indicated for aneurysm formation because of the risk of peripheral embolism, aortic dissection and rupture associated with Kommerell's diverticulum [1, 2]. Although the patient was asymptomatic, surgery was indicated because of Kommerell's diverticulum, aortic dissection and aneurysm diameter enlargement. Surgery for descending aortic aneurysm accompanying right-sided aortic arch has only been described sporadically [3, 4]. Hybrid procedures combining with thoracic endovascular aneurysm repair and bypass has been reported in recent years [5, 6]. Although we considered hybrid procedure, we decided on single-stage surgical repair of extensive thoracic aorta because cervical branch bypass was required, the proximal landing zone peripheral to the right subclavian artery was short, and aortic curvature was severe.
With regard to surgery, unnecessary procedures could be omitted by improving branch anastomosis of the 4-branch artificial vessel, shortening the duration of myocardial ischemia and brain perfusion. In cases with aortic anomalies like the present patient, careful examination of surgical procedures on an individual basis is important.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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