Repair of vascular ring with resection of kommerell diverticulum and transposition of aberrant left subclavian artery.
A 32-year-old female presented with dysphagia. Radiographic studies revealed external compression of esophagus by a vascular ring. The anatomy was a right-sided aortic arch with aberrant retroesophageal left subclavian artery, emanating from a large Kommerell diverticulum (KD). Traditional repair with ligamentum division and adhesiolysis leaves a large KD still adjacent to the esophagus with the potential for persistent or recurrent symptoms. The objective of this study was the modification of operative technique to minimize the potential for persistent or recurrent symptoms. The operative repair included resection of KD with transposition of the left subclavian artery into the left carotid artery, in addition to the division of the ligamentum arteriosum and mobilization of the esophagus. The patient's dysphagia resolved and postoperative barium studies showed no residual compression. There were no significant perioperative complications. Resection of KD is a potential adjunct to traditional repair of vascular rings and might offer better long-term palliation by minimizing residual vascular compression of the esophagus.
Department of General Surgery, Nassau University Medical Center, New York, New York.
John
J
Samas
Department of Cardiothoracic Surgery, Hofstra-North Shore LIJ School of Medicine, New York, New York.
Frank
F
Manetta
Division of Pediatric Cardiothoracic Surgery, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York.
David B
DB
Meyer
aneurysm; artery; ligation; repair; resection; subclavian; transposition