Single-stage repair of complex aortic arch anomaly with aortic regurgitation

Aneurysm of the aberrant left subclavian artery arising from Kommerell's diverticulum is very rare. Early intervention is recommended in such a case to avoid complications. Rarely, such an aneurysm may present with a concomitant cardiac pathology. Surgical approach in this complex scenario is difficult as anatomically distant areas have to be exposed and usually a staged approach is preferred. There are only a few published reports about the same. We report, for the first time, successful single-stage intervention in a patient with aortic regurgitation, right aortic arch, and aneurysmal aberrant left subclavian artery from Kommerell's diverticulum, exclusively through median sternotomy. A 37-year-old gentleman presented with the complaints of palpitations (New York Heart Association grade II) and left-sided neck swelling of 4 months' duration. He also had history of hoarseness of voice for 2 weeks. He was diagnosed to have aortic regurgitation, right aortic arch, and aneurysmal aberrant left subclavian artery from Kommerell's diverticulum and was treated by single-stage repair of the aneurysm and aortic valve replacement with mechanical prosthesis via median sternotomy. Single-stage intervention through midline sternotomy provides excellent outcomes and can be a feasible option for such a complex aortic anomaly.