Right thoracotomy for surgical repair of Kommerell's diverticulum with a right-sided aortic arch and aberrant left subclavian artery: a video case report.

Abstract

Kommerell's diverticulum (KD) combined with a right-sided aortic arch (RAA) and an aberrant left subclavian artery (ALSA) is a rare congenital vascular anomaly causing significant compressive dysphagia. Treatment options, including open surgery, thoracic endovascular aortic repair and hybrid approaches, are debated due to anatomical complexities. We report a 48-year-old female with dysphagia from symptomatic KD, RAA and ALSA, clearly delineated by preoperative computed tomography angiography. A right thoracotomy enabled aortic arch replacement. Deep hypothermic circulatory arrest and retrograde cerebral perfusion were utilized for neuroprotection. KD was resected, and ALSA was reconstructed via interposition graft, anastomosed end-to-side to the main prosthetic graft. Meticulous dissection, including division of the ligament on the diverticulum's greater curvature, and careful handling of fragile aortic tissue with felt-pledgeted sutures were key. The patient recovered uneventfully, with complete dysphagia resolution and discharge on postoperative Day 10, without complications. Right thoracotomy offers excellent exposure for comprehensive repair of complex KD with RAA and ALSA. This case demonstrates the feasibility and effectiveness of open surgical repair with meticulous technique and cerebral protection for favourable outcomes in such rare and challenging vascular anomalies.