Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Ann Thorac Surg. 2019 Jul;108(1):161-166. doi: 10.1016/j.athoracsur.2019.01.062. Epub 2019 Mar 5.
Vascular rings with a Kommerell diverticulum (KD) most commonly occur in patients with a right aortic arch. We report on a less commonly seen subset of vascular ring patients-those with a double aortic arch and a KD.
Between 2002 and 2017, 66 patients underwent an operation for a double aortic arch. Ten of those patients also had excision of a KD. We performed a retrospective medical record review of these patients to characterize their demographics and outcomes.
All 10 patients (7 male, 3 female) had a double aortic arch that was right dominant and also had a KD. The patients were a mean age of 4.9 ± 4.3 years (range, 6 months to 29 years), and median age was 4 years. All patients had preoperative computed tomographic angiography or magnetic resonance imaging and mean compression of the distal trachea of 63% ± 12% (range, 40% to 80%). The distal left arch was atretic in all patients. All patients underwent division of their left aortic arch, division of the ligamentum, and resection of the KD. The left subclavian artery was transferred to the left carotid artery in 2 patients. The mean size of the diverticulum was 9 × 10 mm. There were no major postoperative complications or readmissions. The postoperative length of stay was 3.1 ± 0.8 days. Five of the patients reported no related persisting symptoms. The remaining 5 patients reported substantial symptomatic relief with only minor respiratory symptoms.
Vascular ring patients with a double aortic arch can also have a KD. In addition to dividing the smaller aortic arch and the ligamentum, we recommend excision of the KD.
Kommerell 憩室（KD）合并血管环最常发生于右位主动脉弓患者。我们报告了一种较少见的血管环患者亚组，即双主动脉弓合并 KD。
2002 年至 2017 年间，66 例患者因双主动脉弓接受手术治疗，其中 10 例患者同时切除 KD。我们对这些患者进行了回顾性病历审查，以明确其人口统计学特征和结局。
10 例患者（7 例男性，3 例女性）均存在右优势型双主动脉弓和 KD。患者的平均年龄为 4.9 ± 4.3 岁（范围，6 个月至 29 岁），中位年龄为 4 岁。所有患者均行术前计算机断层血管造影或磁共振成像检查，远端气管受压平均程度为 63% ± 12%（范围，40%至 80%）。所有患者的左主弓均存在先天性缺如。所有患者均接受左主动脉弓离断、韧带离断和 KD 切除术。2 例患者将左锁骨下动脉转流至左颈总动脉。憩室平均大小为 9×10 mm。无重大术后并发症或再入院。术后住院时间为 3.1 ± 0.8 天。5 例患者报告无相关持续症状，5 例患者报告存在明显症状缓解，仅有轻微的呼吸系统症状。
双主动脉弓血管环患者也可能合并 KD。除了离断较小的主动脉弓和韧带外，我们建议切除 KD。
