Right-sided aortic arch with Kommerell's diverticulum: a case report of a rare cause of type B dissection.
Acute aortic syndrome
Aortic dissection
Case report
Congenital aortic anomaly
Kommerell's diverticulum
Right-sided aortic arch
Journal
European heart journal. Case reports
ISSN: 2514-2119
Titre abrégé: Eur Heart J Case Rep
Pays: England
ID NLM: 101730741
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
received:
06
10
2021
revised:
14
12
2021
accepted:
11
06
2022
entrez:
1
7
2022
pubmed:
2
7
2022
medline:
2
7
2022
Statut:
epublish
Résumé
A right-sided aortic arch (RAArch) is present in approximately 0.1% of the population. A Kommerell's diverticulum (KD), a remnant of the dorsal aortic arch usually refers to an aneurysmal aortic enlargement at the origin of an aberrant left subclavian artery (ALSA) and is associated with an increased risk of aortic dissection. A 59-year-old female smoker with a history of hypertension and hypercholesterolaemia presented with a 24-hour history of sudden-onset and severe stabbing chest pain radiating to the interscapular region. Physical examination was normal except for bilateral basal crepitations. Computed tomography angiography (CTA) showed a type B aortic dissection in a RAArch with an ALSA arising from KD with a peri-aortic haematoma and haemothorax without any active contrast extravasation. After medical stabilization, a semi-urgent hybrid repair was performed with a right carotid-subclavian bypass, thoracic endovascular aortic repair (TEVAR), a plug in the left subclavian artery, and left carotid-subclavian bypass due to severe ischaemia of the left arm. The postoperative CTA showed patent bypasses, aortic remodelling, and a minimal type IIa endoleak at the level of the ALSA. In patients with a type B dissection and KD, hybrid repair including TEVAR is feasible after careful pre-operative assessment of the patient's unique anatomy and may reduce post-surgical morbidity and mortality compared to open surgery. Prophylactic repair may be considered in patients with an asymptomatic RAArch and KD.
Sections du résumé
Background
UNASSIGNED
A right-sided aortic arch (RAArch) is present in approximately 0.1% of the population. A Kommerell's diverticulum (KD), a remnant of the dorsal aortic arch usually refers to an aneurysmal aortic enlargement at the origin of an aberrant left subclavian artery (ALSA) and is associated with an increased risk of aortic dissection.
Case summary
UNASSIGNED
A 59-year-old female smoker with a history of hypertension and hypercholesterolaemia presented with a 24-hour history of sudden-onset and severe stabbing chest pain radiating to the interscapular region. Physical examination was normal except for bilateral basal crepitations. Computed tomography angiography (CTA) showed a type B aortic dissection in a RAArch with an ALSA arising from KD with a peri-aortic haematoma and haemothorax without any active contrast extravasation. After medical stabilization, a semi-urgent hybrid repair was performed with a right carotid-subclavian bypass, thoracic endovascular aortic repair (TEVAR), a plug in the left subclavian artery, and left carotid-subclavian bypass due to severe ischaemia of the left arm. The postoperative CTA showed patent bypasses, aortic remodelling, and a minimal type IIa endoleak at the level of the ALSA.
Discussion
UNASSIGNED
In patients with a type B dissection and KD, hybrid repair including TEVAR is feasible after careful pre-operative assessment of the patient's unique anatomy and may reduce post-surgical morbidity and mortality compared to open surgery. Prophylactic repair may be considered in patients with an asymptomatic RAArch and KD.
Identifiants
pubmed: 35775016
doi: 10.1093/ehjcr/ytac238
pii: ytac238
pmc: PMC9237716
doi:
Types de publication
Case Reports
Langues
eng
Pagination
ytac238Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
Références
Gen Thorac Cardiovasc Surg. 2015 May;63(5):245-59
pubmed: 25636900
J Thorac Cardiovasc Surg. 2015 Aug;150(2):409-11
pubmed: 25940410
Interact Cardiovasc Thorac Surg. 2016 Jul;23(1):156-62
pubmed: 27001673
Int J Surg Case Rep. 2017;34:139-143
pubmed: 28411526
J Thorac Dis. 2020 Sep;12(9):4711-4716
pubmed: 33145044
Int J Cardiol. 2017 Aug 1;240:183-186
pubmed: 28483478
Ann Vasc Surg. 2015;29(4):841.e5-12
pubmed: 25733222
Med Clin North Am. 1948 Jul;32:925-49
pubmed: 18877614
Eur Heart J. 2014 Nov 1;35(41):2873-926
pubmed: 25173340
Br Heart J. 1966 Nov;28(6):722-39
pubmed: 5332779
Cardiovasc Diagn Ther. 2018 Apr;8(Suppl 1):S26-S44
pubmed: 29850417
Am J Roentgenol Radium Ther Nucl Med. 1966 Jun;97(2):377-89
pubmed: 5944202