Vascular Rings and Kommerell’s Diverticula

Abstract

This is a textbook of adult aortic surgery. Aberrant great vessels, Kommerell’s diverticula, and double aortic arches often present in infancy or childhood.

Questions and Answers

• SP: Why do Kommerell’s diverticula rarely rupture?

• JAE: Although they represent weak tissue, in the present era, I believe they are diagnosed and treated before they have a chance to rupture. Rupture was more common in the era before 3D imaging by CT and MRI.

• SP: Why are some vascular rings and Kommerell’s diverticula not diagnosed until adulthood? Are these associated with genetic defects, other aortic pathologies or syndromes?

• JAE: The diagnosis as late as adulthood probably reflects that, in some patients, obstructive symptoms are unlikely until the aorta and the aberrant vessel have enlarged with age. Yes, Kommerell’s diverticula are almost always associated with aberrant subclavian vessel.

• SP: Do you ever see these aberrant vessels associated with venous congestion for any reason?

• JAE: No.

• SP: Why do they shed distal emboli?

• JAE: Blood flow is slow at the base of the diverticulum, and slowly flowing blood thickens and clots.