Kommerell's Diverticulum Resection With Left Brachiocephalic Artery Transfer in an Adult With Tracheoesophageal Compression: Off-Pump Sternotomy With External Skin Cooling.

Abstract

Congenital anomalies of the aortic arch often lead to tracheoesophageal compression during childhood. Occasionally, symptoms may not emerge until adulthood, appearing for the first time at any age due to age-related or pathological dilation of the aortic segments. The oldest patient described with symptoms at the onset was 76 years old. Surgical intervention is complex and poses challenges. This case study describes a patient with a right mirror-image branching aortic arch, Kommerell's diverticulum, and a ligamentum arteriosum originating from the diverticulum. The patient first experienced symptoms of tracheoesophageal compression at 57 years of age. Initial treatment at another hospital, which involved division of the ligamentum and incomplete resection of the diverticulum with its fixation to the chest wall, did not alleviate symptoms. Successful off-pump resurgery was performed through a sternotomy, which included complete resection of Kommerell's diverticulum and direct closure of the aorta without the use of a patch. Additionally, the left brachiocephalic artery was repositioned away from the tracheoesophageal complex. External skin surface cooling to 30°C-31°C in the esophagus facilitated safe clamping of the left brachiocephalic artery during the transfer. This case demonstrates successful exposure of Kommerell's diverticulum through sternotomy and the potential to avoid extracorporeal circulation during clamping of the brachiocephalic trunk by utilizing systemic hypothermia with external cooling.