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杂交手术修复 Kommerell 憩室所致主动脉夹层合并右位锁骨下动脉异常

Hybrid repair of aberrant right subclavian artery with aortic dissection caused by Kommerell diverticulum.

机构信息

Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China.

Shanghai Engineering Research Center of Artificial Heart and Heart Failure Medicine, Shanghai, 200120, People's Republic of China.

出版信息

BMC Cardiovasc Disord. 2021 Nov 22;21(1):562. doi: 10.1186/s12872-021-02340-8.

DOI:10.1186/s12872-021-02340-8
PMID:34809569
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8607728/
Abstract

BACKGROUND

Aberrant right subclavian artery (ARSA) with associated Kommerell diverticulum (KD) is a rare congenital aortic disease. KD patients have a high risk of rupture, dissection, and compression of adjacent structures. Although several treatment options have been proposed (traditional surgery, hybrid operation, and endovascular intervention), a consensus regarding optimal surgical management has not yet been established.

CASE PRESENTATION

A case of successful hybrid repair of distal aortic arch dissection aneurysm by dissecting KD and ARSA with debranching of right and left common carotid arteries, left subclavian artery, and stent grafting was presented.

CONCLUSIONS

The hybrid operation is suitable for elderly patients or those with high risks. Along with intervention, the hybrid operation needs to be developed as a minimally invasive method.

摘要

背景

异常右锁骨下动脉（ARSA）伴发 Kommerell 憩室（KD）是一种罕见的先天性主动脉疾病。KD 患者有很高的破裂、夹层和毗邻结构受压的风险。尽管已经提出了几种治疗选择（传统手术、杂交手术和血管内介入治疗），但对于最佳手术治疗方法尚未达成共识。

病例介绍

本文报告了一例成功的杂交手术修复降主动脉夹层动脉瘤的病例，该手术通过对 KD 和 ARSA 进行解剖，并对右颈总动脉、左颈总动脉、左锁骨下动脉进行分支重建，同时进行支架移植。

结论

杂交手术适用于老年患者或高危患者。随着介入技术的发展，杂交手术需要作为一种微创方法进一步发展。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b3a/8607728/6441e3c933a2/12872_2021_2340_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b3a/8607728/b7fc9200bfbe/12872_2021_2340_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b3a/8607728/5b2f374e9f21/12872_2021_2340_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b3a/8607728/ba41a660055a/12872_2021_2340_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b3a/8607728/d5400b48ddf6/12872_2021_2340_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b3a/8607728/6441e3c933a2/12872_2021_2340_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b3a/8607728/b7fc9200bfbe/12872_2021_2340_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b3a/8607728/5b2f374e9f21/12872_2021_2340_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b3a/8607728/ba41a660055a/12872_2021_2340_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b3a/8607728/d5400b48ddf6/12872_2021_2340_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b3a/8607728/6441e3c933a2/12872_2021_2340_Fig5_HTML.jpg

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本文引用的文献

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Single-Stage Hybrid Repair of Right Aortic Arch With Kommerell's Diverticulum.右主动脉弓合并Kommerell憩室的一期杂交修复术
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Evolution in the Management of Aberrant Subclavian Arteries and Related Kommerell Diverticulum.异常锁骨下动脉及相关Kommerell憩室的管理进展
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Kommerell's diverticulum in the current era: a comprehensive review.当代的Kommerell憩室：全面综述
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Arteria lusoria: developmental anatomy, clinical, radiological and surgical aspects.迷走动脉：发育解剖学、临床、放射学及手术学方面
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Frequency of aberrant subclavian artery, arch laterality, and associated intracardiac anomalies detected by echocardiography.超声心动图检测到的异常锁骨下动脉的频率、主动脉弓偏向性及相关心内异常。
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