Early Resection of Kommerell Diverticulum and Revascularization in Children With Right Aortic Arch and Aberrant Left Subclavian Artery.

Abstract

This study aimed to evaluate outcomes for right aortic arch with aberrant left subclavian artery (LSA) in children. This retrospective review included consecutive children undergoing repair through left thoracotomy from 2018 to 2023. Preoperative computed tomography angiography assessed airway compression severity by the tracheal cross-sectional area ratio at vascular ring level (S₁) and at thoracic inlet (S₂), with a lower S₁:S₂ ratio indicating more severe airway compression. Surgery involved Kommerell diverticulum (KD) resection and LSA to left common carotid artery revascularization. A total of 109 patients were included. Sizable KDs were present in 79.8%; 34.9% were symptomatic, and 34.0% had LSA origin stenosis. Preoperative S₁:S₂ ratio (0.59 ± 0.14) indicated significant airway compression, improving postoperatively to 0.87 ± 0.14 (P < .001). Larger diverticula correlated with more severe preoperative compression and greater postoperative improvement. All patients achieved symptom resolution or marked relief. One-year computed tomography angiography confirmed 100% LSA anastomosis patency. No mortality or major complications occurred. Surgical repair of right aortic arch with aberrant LSA with KD resection and LSA revascularization effectively relieves airway compression, demonstrating excellent midterm outcomes. Early intervention in symptomatic patients or those with high anatomic risk ensures durable symptom relief and vascular patency. This approach is safe and efficacious for pediatric vascular ring anomalies.