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J Thorac Cardiovasc Surg 2006;131:574-578
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Surgical treatment for Kommerell's diverticulum

^a Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe
^b Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo
^c Department of Cardiovascular Surgery, Kawasaki-Saiwai Hospital, Kawasaki, Japan

Received for publication July 19, 2005; revisions received September 9, 2005; accepted for publication October 7, 2005.

^_* Address for reprints: Yutaka Okita, MD, Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Japan 650-0017 (Email: yokita{at}med.kobe-u.ac.jp).

OBJECTIVE: Kommerell's diverticulum, which is a rare condition, is a congenital abnormality of the aortic arch. The strategy of surgical treatment for Kommerell's diverticulum has not been established.

METHODS: Between 1994 and 2004, 6 patients underwent surgery for Kommerell's diverticulum at our institute. Diagnoses included right aortic arch with aberrant left subclavian artery in 4 patients and left aortic arch with aberrant right subclavian artery in 2 patients. Indications for surgery were dilatation of Kommerell's aneurysm (n = 4) and dysphagia (n = 2). One patient underwent total arch replacement through the median sternotomy plus right thoracotomy. Five patients underwent replacement of the descending aorta and reconstruction in situ (n = 4) or ligation (n = 1) of the stenotic aberrant subclavian artery through the right (n = 3) or left (n = 2) thoracotomy.

RESULTS: There were no patient deaths or patients who required rehospitalization. Mediastinitis occurred in 1 patient. This patient required mediastinal drainage and an omentopexy. Two patients who had dysphagia became asymptomatic. Postoperative angiographies in all patients were satisfactory. The patient whose aberrant subclavian artery was ligated had no ischemic symptom of the arm. At the midterm outcomes (mean follow-up length was 55.6 ± 42.2 months, ranging 10-114 months), all patients resumed normal activities without any complications.

CONCLUSIONS: Kommerell's diverticulum can be repaired safely with graft replacement concomitant with in situ reconstruction of the aberrant subclavian artery through thoracotomy.

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