Aneurysmal dilatation of the proximal part of an aberrant left subclavian artery (in case of right aortic arch) or an aberrant right subclavian artery (in case of left aortic arch). It is often associated with another anomaly of the aortic arch. Embryologically, it is a residue of the 4th dorsal aortic arch.
Symptoms:
- childhood: stridor or tracheal compression or dysphagia
- adult: dysphagia. Sometimes dissection or rupture of the aneurysmal portion. This is why it is recommended to resect it if the diverticulum is symptomatic, if its diameter is > 1.5 times that of the subclavian artery or if pulsations are observed at the posterior part of the trachea during bronchoscopy.
Anesthetic implications:
risk of localized tracheo-bronchomalacia; repair in children can be realized without aortic clamping; in adults, it is necessary to clamp the aorta which implies a unipulmonaire ventilation, a cardiac bypass (sometimes limited to left heart) even under deep hypothermia circulatory arrest. Carefuf use of transesophageal echography: risk of rupture ?
References :
- Cannavale A, Francone M, Galea N, Roggini M, Carbone I.
Three-dimensional Magnetic resonance imaging of Kommerell diverticulum in a child with recurrent dysphagia.
J Pediatr Surg 2010; 45: 2092-3.
- Bhandary SP, Papadimos TJ, Svensson LG, Sale S.
Anesthetic management of the resection of a Kommerell’s diverticulum.
J Cardiothor Vasc Anesth 2015; 29: 142-5
- Herway ST, Benumof JL, Golts E, Manecke GR.
Major positional obstruction of the trachea in a patient with right-sided aortic arch and Kommerell’s diverticulum.
J Cardiothor Vasc Anesth 2015; 29: 146-8
Updated: February 2019