Successful Thoracic Endovascular Aortic Repair of Kommerell Diverticulum to Relieve Refractory Chest Oppressions Caused by Secondary Esophageal Stricture

An 83-year-old woman with refractory chest oppression presented to hospital. Her symptoms resembled angina pectoris, but nitroglycerin was ineffective. Electrocardiography showed no ST-T changes (Figure A). Contrast-enhanced computed tomography (CECT) indicated no significant coronary artery stenosis (Figure B), but revealed a right-sided aortic arch and Kommerell diverticulum (KD) causing esophageal compression (Figure C; Supplementary Movie 1). Fluoroscopic esophagography confirmed the diagnosis of the esophageal stricture as the cause of the chest oppressions (Figure D). To alleviate the symptoms, minimally invasive thoracic endovascular aortic repair (TEVAR) was performed from the distal site of the right subclavian artery that covered the entry of the KD. Postoperative CECT after 1 week revealed blood flow occlusion to the KD and the esophageal stricture was relieved (Supplementary Move 2). Fluoroscopic esophagography revealed an improvement in the stenosis, and chest tightness resolved (Figure E).

Figure.

(A) Electrocardiogram shows sinus rhythm without ST-T changes. (B) Contrast-enhanced computed tomography (CECT) shows no considerable coronary artery stenosis, but does reveal (C) Kommerell diverticulum (KD) (arrowheads) and compressed esophagus (arrow). (D) CECT shows esophageal compression (yellow-highlighted area) by the KD. Fluoroscopic esophagography reveals the esophageal stricture (yellow arrow). (E) Postoperative CECT and fluoroscopic esophagography both show that the endovascular aortic repair occluded blood flow to the KD and removed the esophageal compression (yellow arrow).

KD is an aortic diverticulum caused by abnormal development of the dorsal aortic arch. KD with a right-sided aortic arch may lead to dysphasia or chest pain.¹ The standard treatment for KD is surgical aortic repair, but TEVAR is an acceptable treatment option for older patients.¹ We conclude that KD may cause refractory chest oppression and that TEVAR is a minimally invasive and effective treatment.

Declarations

The authors have no conflicts of interest to declare.

Supplementary Files

Supplementary Movie 1. CECT images before TEVAR.

Supplementary Movie 2. CECT images after TEVAR.

Please find supplementary file(s);

https://doi.org/10.1253/circj.CJ-24-0228

Reference

• 1.   Bloom JP, Attia RQ, Sundt TM, Cameron DE, Hedgire SS, Bhatt AB, et al. Outcomes of open and endovascular repair of Kommerell diverticulum. Eur J Cardiothorac Surg 2021; 60: 305–311.