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Juraszek A, Berger T, Kreibich M, Tsagakis K, Sioris T, Berkarda Z, Rylski B, Siepe M, Czerny M. Treatment of right-sided aortic arch aneurysms with aberrant left subclavian artery with Kommerell's diverticulum using the frozen elephant trunk technique. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad188. [PMID: 38011667 PMCID: PMC10723034 DOI: 10.1093/icvts/ivad188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/24/2023] [Accepted: 11/25/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The ideal treatment for aneuryms of aberrant left subclavian arteries with Kommerell's diverticulum arising from right aortic arches remains open. METHODS Between January 2015 and December 2020, 5 patients with aneurysms from a right-sided aortic arch with aberrant left subclavian artery and Kommerell's diverticulum underwent repair by using the frozen elephant trunk technique in 3 aortic centres. Patients' characteristics were retrospectively reviewed and the surgical procedure and outcomes are presented. RESULTS The median age of the 2 male and 3 female patients was 59 (range from 49 to 63) years. The median operative times were as follows: surgery 405 min (range from 335 to 534), cardiopulmonary bypass time 244 min (range from 208 to 280) and aortic clamp time 120 min (from 71 to 184). The mean core temperature was 25.94°C (from 24 to 28). The intensive care unit stay was 4 days (range from 1 to 8) and the in-hospital stay 21 days (from 16 to 34). All patients were discharged and we observed no stroke or spinal cord ischaemia postoperatively. During the median follow-up time of 1003 days (range from 450 to 2306), 3 patients required subsequent thoracic endovascular distal stent graft extension. CONCLUSIONS The frozen elephant trunk technique is a good treatment option for patients with aneuryms of an aberrant left subclavian artery with Kommerell's diverticulum arising from right aortic arches. Secondary stent graft extension is a frequently needed component of the treatment concept.
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Affiliation(s)
- Andrzej Juraszek
- Department of Cardiovascular Surgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tim Berger
- Department of Cardiovascular Surgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Konstantinos Tsagakis
- Department of Cardio-thoracic Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Thanos Sioris
- Department of Cardiac Surgery, University Hospital Tampere, Tampere, Finland
| | - Zeynep Berkarda
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Czerny
- Department of Cardiovascular Surgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Shadanov AA, Sirota DA, Lyashenko MM, Kobelev E, Khomushku DOV, Chernyavskiy AM. [Hybrid treatment of Kommerell diverticulum and giant aneurysm of intra-thoracic segment of aberrant left subclavian artery]. Khirurgiia (Mosk) 2023:90-93. [PMID: 36800875 DOI: 10.17116/hirurgia202303190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Kommerell's diverticulum causes compression of the esophagus, trachea and laryngeal nerve between the aberrant mouth of the left subclavian artery and ascending aorta. This leads to dysphagia or shortness of breath. We describe hybrid treatment of the right aortic arch with Kommerell's diverticulum and giant aneurysm of the aberrant left subclavian artery.
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Affiliation(s)
- A A Shadanov
- Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - D A Sirota
- Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - M M Lyashenko
- Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - E Kobelev
- Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - D-O V Khomushku
- Meshalkin National Medical Research Center, Novosibirsk, Russia
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Nishioka N, Iba Y, Bochimoto H, Tsukagoshi J, Masuda T, Yanase Y, Maruyama R, Hatta E, Kurimoto Y, Yamada A. Ultrastructural Features of the Aortic Wall in a Patient with Kommerell Diverticulum. Ann Vasc Surg 2021; 74:525.e1-525.e6. [PMID: 33831520 DOI: 10.1016/j.avsg.2021.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
We report on the ultrastructural features of the aortic wall in a patient with Kommerell diverticulum. A 70-year-old woman with a right aortic arch, aberrant left subclavian artery, and Kommerell diverticulum underwent a successful total arch replacement plus the frozen elephant trunk procedure with anatomical left subclavian artery reconstruction. Small pieces of the ascending aorta, distal arch, right common carotid artery, and left subclavian artery were investigated ultrastructurally. In the ascending aortic wall, multiple cystic cavities were observed in the subintimal region of the media by scanning electron microscopy. Changes in organelles, including mild dilation of rough-surfaced endoplasmic reticulum and mitochondrial swelling and degrading, were also observed in all specimens by transmission electron microscopy. These ultrastructural features may indicate the fragility or stress of the aortic wall and are useful when considering the early surgical intervention of a patient with Kommerell diverticulum.
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Affiliation(s)
- Naritomo Nishioka
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Hokkaido, Japan.
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Hiroki Bochimoto
- Division of Aerospace Medicine, Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Junji Tsukagoshi
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Takahiko Masuda
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Yohsuke Yanase
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Ryushi Maruyama
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Eiichiro Hatta
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Yoshihiko Kurimoto
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Akira Yamada
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Hokkaido, Japan
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