Transmediastinal Resection of Kommerell Diverticulum with Left Subclavian Artery Transfer to the Left Carotid Artery
Osama M. Eltayeb, MD, Michael C. Monge, MD, Andrada R. Popescu, MD, Carl L. Backer, MD.
Ann & Robert H Lurie Childrens Hospital of Chicago, Chicago, IL, USA.
A 5-year-old, 18 kg boy with noisy breathing was found to have tracheal stenosis secondary to complete cartilage tracheal rings. He also had a vascular ring consisting of a right aortic arch, left ligamentum, retroesophageal left subclavian artery, and a Kommerell diverticulum. This movie illustrates repair of the vascular ring through a median sternotomy approach. The patient was on cardiopulmonary bypass for the slide tracheoplasty. The operative approach to the Kommerell diverticulum was quite different from approaching it through the left thoracotomy. The key technical steps were to trace the left ligamentum down to the Kommerell diverticulum. This was then carefully dissected away from the esophagus. The base of the diverticulum was occluded with a vascular clamp. The diverticulum was resected and the left subclavian artery was transferred to the left carotid artery using partial occlusion clamps, again; this was quite a different approach from a left thoracotomy. The patient had pre- and postoperative computed tomography images that demonstrate the preoperative anatomy and successful postoperative result.
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