Department of Cardiovascular Surgery, Takaishi Fujii Cardiovascular Hospital, 2-15-18 Ayazono, Takaishi-shi, Osaka, 592-0014, Japan.
Department of Radiology, Nara Medical University, 840 Shijo, Kashihara-shi, Nara, 634-8521, Japan.
Interact Cardiovasc Thorac Surg. 2022 Jul 9;35(2). doi: 10.1093/icvts/ivac075.
The best treatment for a right-sided aortic arch (RAA) and Kommerell diverticulum (KD) has not been determined due to the rarity of these conditions. The current trend in the treatment of this disease is to increase the endovascular approach without a sternotomy. We describe a rare condition with an association of an RAA with a KD of an aberrant left subclavian artery and an anomalous right vertebral artery originating from the aortic arch (AVA). The left vertebral artery was missing. Also, there was an incomplete circle of Willis due to the absence of the left and right posterior communication arteries. Therefore, the AVA was the only artery to supply the vertebral-basilar system. In our case, a simple thoracic endovascular aortic repair was not suitable because of the sharply curved arch and short landing zone. Also, a debranching thoracic endovascular aortic repair was not appropriate because that approach would not permit reconstruction of the AVA. The patient successfully underwent a total arch replacement with the frozen elephant trunk technique. This procedure could be an effective option for patients with RAAs with KDs associated with another arch vessel anomaly.
由于右位主动脉弓（RAA）和 Kommerell 憩室（KD）的罕见性，尚未确定其最佳治疗方法。目前，这种疾病的治疗趋势是增加不经胸骨切开的血管内方法。我们描述了一种罕见的情况，即 RAA 合并 KD、左锁骨下动脉异常和起源于主动脉弓的异常右椎动脉（AVA）。左椎动脉缺失。此外，由于左、右后交通动脉缺失，Willis 环不完整。因此，AVA 是供应椎基底动脉系统的唯一动脉。在我们的病例中，由于弓部急剧弯曲和短着陆区，单纯的胸主动脉腔内修复术不合适。此外，分支型胸主动脉腔内修复术也不合适，因为这种方法不允许重建 AVA。患者成功接受了全主动脉弓置换术，采用冷冻象鼻技术。对于 RAA 合并 KD 合并另一个弓状血管异常的患者，该手术可能是一种有效的选择。
