title: 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.affiliation: Pediatric and Congenital Cardiology and Thoracic and Cardiovascular Surgery, Assistance Publique - Hôpitaux de Marseille, Hôpital Timone Enfants, Marseille, France.
authors.forename: Deborah
authors.initials: D
authors.lastname: Luciano
authors.affiliation: Cardiothoracic Surgery and Cardiac Transplantation, Hôpital Louis Pradel, Bron cedex, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Mitchell
authors.affiliation: Pediatric and Congenital Cardiology and Thoracic and Cardiovascular Surgery, Assistance Publique - Hôpitaux de Marseille, Hôpital Timone Enfants, Marseille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Fraisse
authors.affiliation: Pathologic Anatomy Service, Assistance Publique - Hôpitaux de Marseille, Hôpital Timone, Marseille, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Lepidi
authors.affiliation: Aix Marseille Université, Medical Genetics and Functional Genomics, INSERM UMR_S 910, Marseille, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Kreitmann
authors.affiliation: Pediatric and Congenital Cardiology and Thoracic and Cardiovascular Surgery, Assistance Publique - Hôpitaux de Marseille, Hôpital Timone Enfants, Marseille, France. Electronic address: caroline.ovaert@ap-hm.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Ovaert
mesh_terms: D000293:Adolescent; D000783:Aneurysm / Q000175:diagnosis / Q000601:surgery*; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000601:surgery; D001015:Aortic Arch Syndromes / Q000175:diagnosis / Q000601:surgery*; D018376:Cardiovascular Abnormalities / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000175:diagnosis / Q000601:surgery*; D004240:Diverticulum / Q000175:diagnosis / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000002:abnormalities* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult