Kommerell’s Diverticulum with aberrant right subclavian artery

Posted by Jackie Bell @jbell22, Feb 7, 2017

I have a right facing aorta with an abhorrent left subclavian artery and a kommerellis diverticulum. I have had one surgery and am looking at more. My question/query is this: does anyone with a heart condition get heart pain just from talking? The more I talk (just with friends, on the phone etc) and the louder I talk increases my pain. My surgeon is suggesting now that I might have an aorta which is attached to my breastbone and I might now need an aortapexy - symptoms being the talking issue. Anyone familiar with this? ☺

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@mrsr1234

So, I will start with, a not comforting statement, of I know how you feel. I was in and out of the ER too many times to count and the cardiologist told me twice that “it wasn’t my heart” (guess he missed it on the radiology report) but I have the zipper (open heart surgery scar) to prove it. Anyway, I would think that once Mayo gets the correct diagnosis, either there or Johns Hopkins would be your best bet. I should’ve gone to Hopkins. That’s a different story. I’ve been a cardiac RN for 20+ years and found and basically diagnosed myself which is how I ended up at the surgeon. However, the barium swallow is ‘gold standard’ for diagnosis as it will really show the ARSA obstruction (as mine did) - fyi… it sucks if you’ve never had one before. Words of advice: research your surgeon. And I cannot stress this enough: STAY OFF GOOGLE. It is not your friend. I have reputable peer-reviewed articles and sites regarding this subject if you’d like them. Let me know if you have any questions. Keep your head up it’s a marathon not a sprint.

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@mrsr1234, Thanks for sharing your experience. You are so right to say stay away from Google. Lots of scary and other less reputable information that pops up if you don't do your do diligence looking for peer reviewed information. I did find this July 2023 article on the topic that I'm hoping might be helpful until you can share the articles you mentioned for @pinkcarmen and @jbell22.

--- Minimally invasive approach in symptomatic aberrant right subclavian artery treatment: https://www.sciencedirect.com/science/article/pii/S2210261223005631

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@pinkcarmen

Thank you so much! I would love the articles and all the info you have. I really appreciate it.

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So these are just a few... I only look at journal articles that have been peer-reviewed & nothing (ever) more than 10 years old. Also, I only ever base what information I "believe" off of the information I find on these sites: mayo clinic, johns hopkins, Cleveland clinic, nih.gov or https://www.ncbi.nlm.nih.gov/ Hope this helps!!
https://www.jacc.org/doi/10.1016/j.jaccas.2019.12.043
https://pubmed.ncbi.nlm.nih.gov/32949736/#:~:text=Technical%20and%20clinical%20success%20rates,in%20specialized%20centers%20is%20vital
https://academic.oup.com/icvts/article/35/5/ivac230/6731932
https://www.aats.org/resources/2520
https://www.annalsofvascularsurgery.com/article/S0890-5096(23)00263-7/fulltext

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@mrsr1234

So these are just a few... I only look at journal articles that have been peer-reviewed & nothing (ever) more than 10 years old. Also, I only ever base what information I "believe" off of the information I find on these sites: mayo clinic, johns hopkins, Cleveland clinic, nih.gov or https://www.ncbi.nlm.nih.gov/ Hope this helps!!
https://www.jacc.org/doi/10.1016/j.jaccas.2019.12.043
https://pubmed.ncbi.nlm.nih.gov/32949736/#:~:text=Technical%20and%20clinical%20success%20rates,in%20specialized%20centers%20is%20vital
https://academic.oup.com/icvts/article/35/5/ivac230/6731932
https://www.aats.org/resources/2520
https://www.annalsofvascularsurgery.com/article/S0890-5096(23)00263-7/fulltext

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Thank you! Very helpful- I will be forwarding them to my cardiologist.

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@jbell22

Thank you! Very helpful- I will be forwarding them to my cardiologist.

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Glad you found it useful. While it will be helpful for your cardiologist to know about your diagnosis and symptoms etc, this is a very specialized condition, the very special eye surgery, and last I looked. There were only like three guys in the country who could do the surgery. Hence, why I said before to research the cardiovascular surgeon. Plus, it is usually a surgery that has two components, vascular surgeon, and the cardiovascular surgeon who operate in conjunction with each other. So please ask whoever you decide on if surgery is required LOTS of questions. Especially, how many times have you successfully done this operation yourself

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Appreciate your response. I have a right facing aorta with an abhorrent left subclavian artery and a Kommerelis Diverticulum. This is mentioned in 3 of the articles. I am in Canada and have had one open heart surgery where they had to go through the back because of the backwards aorta pressing too high against the sternum (and because the abhorrent left subclavian had embedded into my spinal column). Some work was done but the KD is still there and is at 5.7 cm. The hybrid technique has been mentioned but I didn't really understand it. My cardiologist has said he was looking into it. It is probably more challenging bring in Canada and I'm not sure how that will work for me (surgery in the US).

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@jbell22

Appreciate your response. I have a right facing aorta with an abhorrent left subclavian artery and a Kommerelis Diverticulum. This is mentioned in 3 of the articles. I am in Canada and have had one open heart surgery where they had to go through the back because of the backwards aorta pressing too high against the sternum (and because the abhorrent left subclavian had embedded into my spinal column). Some work was done but the KD is still there and is at 5.7 cm. The hybrid technique has been mentioned but I didn't really understand it. My cardiologist has said he was looking into it. It is probably more challenging bring in Canada and I'm not sure how that will work for me (surgery in the US).

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So, wow. I'm really at a loss of how to reply to this. 🙁 So, I'm going to leave you with some more information. These are great articles I found:
https://www.mdpi.com/2308-3425/8/3/25
https://www.annalscts.com/article/view/16883/17500
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600113/#:~:text=Open%20surgical%20treatment%20has%20been,arch%20replacement%20through%20a%20median
https://www.cmaj.ca/content/181/8/498
If your cardiologist does not specialize in this & has never treated this, he will likely refer you to a specialist. Best of luck!!!!

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Hello @pinkcarmen
I think it is important to have some more studies done. ARSA is rare to find but actually more common just not usually diagnosed. Not everyone has an ARSA that rings or affects the esophagus- majority of them I think are like mine simply in the wrong place but work fine and have to impediment on other structures- which leads normal cardiologist to brush them off sometimes. Reach out to major cardiology centers- if you’re not happy with Mayo try Cleveland Clinic. I got my second opinion from them- they also deal with less common cardiology issues more often. Don’t give up- you are your best advocate and know your body best- and you will find a medical team you feel comfortable and secure with- unfortunately it may take to searching though.

Jeane

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Thank you so much, I am looking for other doctors for consults. Have not contacted the Cleveland clinic yet but I will, Thank you for the suggestion. You mention your ARSA does not affect your esophagus, Have you gotten chest pain or any other symptom caused by ARSA.?

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Hey there, I totally get where you're coming from – heart issues can be a real puzzle. I had a similar journey and found answers on the site wegood.life with the help of a doctor Hanna Romanenko.
My surgeon gave me some insights that eased my worries and put things into perspective.

If you're in the same boat, don't hesitate. Expert guidance can really make things clearer. And hey, remember, you've got a whole community here rooting for you and sharing their journeys too.

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@pinkcarmen

Thank you so much, I am looking for other doctors for consults. Have not contacted the Cleveland clinic yet but I will, Thank you for the suggestion. You mention your ARSA does not affect your esophagus, Have you gotten chest pain or any other symptom caused by ARSA.?

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Well, it may vary person to person because mine was totally compressing my esophagus and basically choking me out. Not all people have all the same symptoms or experiences.

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