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Vol. 69. Issue 7.
Pages 696 (July 2016)
Image in cardiology
DOI: 10.1016/j.rec.2016.02.022
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Kommerell Diverticulum and Aberrant Right Subclavian Artery
Divertículo de Kommerell y arteria subclavia derecha aberrante
José Manuel Villaescusa
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Corresponding author:
, José Aurelio Sarralde, Juan Francisco Nistal
Servicio de Cirugía Cardiovascular, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
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The present case concerns a 53-year-old man with a 4-month history of symptoms of dysphagia lusoria who attended our emergency department for chest pain. The patient was sweaty and hypertensive (210/100 mmHg). Electrocardiography showed sinus tachycardia without evidence of myocardial ischemia or altered repolarization. Urgent computed tomography ruled out acute aortic dissection but revealed a left aortic arch with bovine trunk, an aberrant right subclavian artery, and a Kommerell diverticulum (Figures 1 and 2) with a periaortic hematoma. Transthoracic echocardiography and coronary angiography were performed, with no abnormal findings. A 2-stage surgical intervention was indicated.

Figure 1
Figure 2

First, the right subclavian artery was transposed to the right common carotid artery. Second, via left thoracotomy and left heart bypass with extracorporeal circulation, the Kommerell diverticulum was replaced with a 26-mm Dacron graft and the left subclavian artery was reimplanted using an 8-mm Dacron graft (Figure 3). The presence of an aberrant right subclavian artery is an infrequent finding (0.2%-2.5%) but it has been seen to be the cause of aortic dissection complications and, as in this patient, the origin of a Kommerell diverticulum. Suspicion is based on the presence of dysphagia lusoria. The treatment for Kommerell diverticulum and aberrant subclavian artery is surgical, with excellent results. Endovascular treatment is a valid and recently introduced option.

Figure 3
Copyright © 2016. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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