Kommerell 憩室：区分弓侧和评估形态、大小和风险。
Kommerell Diverticulum: Distinctions Between Arch Side and Evaluation of Morphology, Size, And Risk.
机构信息
University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan; University of Michigan Adult Congenital Heart Disease Program, Ann Arbor, Michigan.
University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
出版信息
Ann Thorac Surg. 2022 Sep;114(3):848-856. doi: 10.1016/j.athoracsur.2021.06.035. Epub 2021 Jul 18.
BACKGROUND
Kommerell diverticulum (KD) is a dilated proximal aberrant right or left subclavian artery associated with either right or left aortic arches (RAA-ARSA or LAA-ALSA). Although case series suggest that KD may be a liability for vascular complications, the risk, pattern of dilation throughout the life span, and differences between arch sides are not known.
METHODS
This study was a single-center retrospective review of patients of all ages with KD on cross-sectional imaging. Maximal short-axis diameter of KD (KDmax), absolute and indexed to descending aortic diameter (DAo), was correlated with age. Comparisons were made between arch sides. Patients with vascular complications were described.
RESULTS
A total of 104 patients with KD were included: 68 (65%) with RAA-ALSA, 36 (35%) with LAA-ARSA, 43 (41%) asymptomatic. Although KDmax was correlated with age (RAA-ALSA r = 0.84; [P< .0001]; LAA-ARSA r = 0.51 [P = .001]), KDmax indexed to DAo was not (RAA-ALSA r = 0.14 [P = .27]; LAA-ARSA r = -0.22 [P = .21]). Patients with RAA-ALSA had larger KDmax indexed to DAo (1.02 ± 0.20 mm/mm vs 0.89 ± 0.18 mm/mm; P = .002) and more symptoms (75% vs 28%; P < .0001), and they were younger (median, 9.5 years vs 61.7 years; P < .0001). Six patients (58 to 80 years of age) had vascular complications, and all 6 had LAA-ARSA and risk factors for acquired aneurysms.
CONCLUSIONS
In older patients, KDmax indexed to DAo was not larger, thus arguing against isolated KD dilation with age. Diverticula from RAA-ALSA and LAA-ARSA demonstrated different phenotypes, a finding suggesting different disease processes and likely different risk. The incidence of vascular complications was lower than in previous reports, and these complications occurred exclusively in patients with LAA-ARSA and aneurysm risk factors. This finding suggests that conservative management of asymptomatic KD is often reasonable, especially in patients with RAA-ALSA.
背景
Kommerell 憩室（KD）是一种近端异常扩张的右或左锁骨下动脉，与右或左主动脉弓（RAA-ARSA 或 LAA-ALSA）有关。尽管病例系列表明 KD 可能存在血管并发症的风险，但 KD 在整个生命周期中的扩张模式以及弓侧之间的差异尚不清楚。
方法
本研究是对在横断面成像上具有 KD 的所有年龄段患者的单中心回顾性研究。KD 的最大短轴直径（KDmax）、绝对直径和与降主动脉直径（DAo）的比值（KDmax/DAo）与年龄相关。比较了弓侧之间的差异。描述了有血管并发症的患者。
结果
共纳入 104 例 KD 患者：68 例（65%）为 RAA-ALSA，36 例（35%）为 LAA-ARSA，43 例（41%）无症状。尽管 KDmax 与年龄相关（RAA-ALSA r = 0.84；P<.0001；LAA-ARSA r = 0.51 [P =.001]），但 KDmax/DAo 与年龄不相关（RAA-ALSA r = 0.14 [P =.27]；LAA-ARSA r = -0.22 [P =.21]）。RAA-ALSA 患者的 KDmax/DAo 更大（1.02 ± 0.20 mm/mm 与 0.89 ± 0.18 mm/mm；P =.002），症状更多（75% 与 28%；P <.0001），且年龄更小（中位数 9.5 岁与 61.7 岁；P <.0001）。6 例患者（58 至 80 岁）发生血管并发症，均为 LAA-ARSA，且有获得性动脉瘤的危险因素。
结论
在老年患者中，KDmax/DAo 并不更大，因此不支持单纯 KD 随年龄增长而扩张。来自 RAA-ALSA 和 LAA-ARSA 的憩室表现出不同的表型，这一发现表明不同的疾病过程，可能存在不同的风险。血管并发症的发生率低于之前的报道，这些并发症仅发生在 LAA-ARSA 且有动脉瘤危险因素的患者中。这一发现表明，无症状 KD 的保守治疗通常是合理的，尤其是在 RAA-ALSA 患者中。
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