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Velandia-Sánchez A, Gómez-Galán S, Gallo-Bernal S, Polania-Sandoval CA, Pineda-Rodríguez IG, Florez-Amaya P, Sanabria-Arévalo LM, Senosiain-González J, Barrera-Carvajal JG, Umana JP, Camacho-Mackenzie J. Emergent hybrid surgical approaches for non-dissecting ruptured Kommerell's aneurysm: a case report series. J Cardiothorac Surg 2023; 18:93. [PMID: 36964599 PMCID: PMC10037773 DOI: 10.1186/s13019-023-02156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/24/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Kommerell's aneurysm is a saccular or fusiform dilatation found in 3-8% of Kommerell's diverticulum cases. A non-dissecting rupture rate of 6% has been reported. If ruptured, emergent surgical correction is usually granted. However, evidence regarding the optimal surgical approach in this acute setting is scarce. In this case report series, we aim to describe our experience managing type-1 non-dissecting ruptured Kommerell's aneurysm with hybrid emergent surgical approaches. CASES PRESENTATION From January 2005 to December 2020, three cases of type-1 non-dissecting ruptured Kommerell's aneurysm requiring emergent surgical repair were identified. The mean age was 66.67 ± 7.76 years, and 3/3 were male. The most common symptoms were atypical chest pain, dyspnoea, and headache (2/3). The mean aneurysm's diameter was 63.67 ± 5.69 mm. Frozen Elephant Trunk was the preferred surgical approach (2/3). The Non-Frozen Elephant Trunk patient underwent a hybrid procedure consisting of a supra-aortic debranching and a zone-2 stent-graft deployment. We found a mean clamp time of 140 ± 60.75 min, cardiac arrest time of 51.33 ± 3.06 min, and a hospital stay of 13.67 ± 5.51 days. The most common complications were surgical-site infection and shock (2/3). Only one patient died (1/3). CONCLUSION Evidence of management for non-dissecting ruptured Kommerell's aneurysms is scarce. Additional, robust, and more extensive studies are required. The selection of the appropriate surgical approach is challenging, and each patient should be individualized. Frozen Elephant Trunk was feasible for patients requiring emergent surgical repair in our centre. However, other hybrid or open procedures can be performed.
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Affiliation(s)
- Alejandro Velandia-Sánchez
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia.
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
| | - Sebastián Gómez-Galán
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Sebastian Gallo-Bernal
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- Division of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Camilo A Polania-Sandoval
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Ivonne G Pineda-Rodríguez
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
| | - Paula Florez-Amaya
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Lina M Sanabria-Arévalo
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | | | - Juan G Barrera-Carvajal
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Juan P Umana
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Jaime Camacho-Mackenzie
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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Mattioli M, Pagliariccio G, Martino GP, Marconi F. Unusual cause of back pain and dysphagia: a Kommerell aneurysm. BMJ Case Rep 2020; 13:e237337. [PMID: 32843468 PMCID: PMC7449308 DOI: 10.1136/bcr-2020-237337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Massimo Mattioli
- Emergency Department, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Gabriele Pagliariccio
- Vascular Surgery Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Giuseppe Pio Martino
- Internal Medicine, Area Vasta 4 Fermo, Azienda Sanitaria Unica Regionale, Ancona, Marche, Italy
| | - Fabio Marconi
- Area Vasta 4 Fermo, Azienda Sanitaria Unica Regionale, Ancona, Marche, Italy
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Robles TA, Srinivasan A, Mazur L, Gourishankar A. Kommerell's Diverticulum With a Twist: A Case of Recurrent Wheeze in an 8-Year-Old Boy. Glob Pediatr Health 2019; 6:2333794X19897506. [PMID: 31903415 PMCID: PMC6926987 DOI: 10.1177/2333794x19897506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/05/2019] [Accepted: 12/06/2019] [Indexed: 11/16/2022] Open
Abstract
Kommerell's diverticulum is a rare, congenital aortic arch anomaly, usually associated with other vascular abnormalities. When present with a concurrent right-sided aortic arch and an aberrant subclavian artery, this triad can form a vascular ring that encompasses the trachea and esophagus. This anatomical variant is usually asymptomatic but can present with respiratory symptoms due to compression of the trachea. In this report, we discuss a case of a Kommerell's diverticulum, which presented as frequent and recurring asthma exacerbations in a pediatric patient.
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Affiliation(s)
| | | | - Lynnette Mazur
- University of Texas Health Sciences Center at Houston, TX, USA
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