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? Thank you. ☺

Hi, not sure if this is still active. I am going to see a specialist for unrelated issues and was going through old reports/data. I am 37 year old male and 10 years ago, doctor thought I had cancer and wanted to see if it spread so did a chest CT scan. It turned out to be false alarm and he was wrong and there was no cancer anywhere. I just looked at the report and actually read it where it mentions incidental finding of aberrant right subclavian artery stemming from diverculosis kommerell. The doctor never brought this up to me 10 years ago. I am in the process of setting up appointment with a vascular surgeon and would imagine I need current imaging. Have any of you have this? Is this something that you just live with and it's not an issue? What sort of lab work/imagining did you have on this? Did you put in stents? Any info on this would be much appreciated! There is really not much on the web about this.

Thank you!

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Hi @akeyfes, welcome to Mayo Clinic Connect. How disheartening to know that something was found on your imaging, but not addressed.
I know that members like @jbell22 and @ggopher who not only posted here, but also in another discussion regarding kommerell diverticulum.
https://connect.mayoclinic.org/discussion/right-facing-aorta-with-kommerellis-diverticulum/
You may be interesting in this NIH article as well:
– Kommerell's diverticulum: A rare aortic arch anomaly https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192231/

Have you been asymptomatic or have you had any swallowing or breathing issues?

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@amandaburnett

Hi @akeyfes, welcome to Mayo Clinic Connect. How disheartening to know that something was found on your imaging, but not addressed.
I know that members like @jbell22 and @ggopher who not only posted here, but also in another discussion regarding kommerell diverticulum.
https://connect.mayoclinic.org/discussion/right-facing-aorta-with-kommerellis-diverticulum/
You may be interesting in this NIH article as well:
– Kommerell's diverticulum: A rare aortic arch anomaly https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192231/

Have you been asymptomatic or have you had any swallowing or breathing issues?

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Asymptomatic. In fact as of last week I was doing an hour of hardcore cycling and heavy weightlifting 6 days a week. I am just in horror that I may have been literally risking my life with each rep. It is beyond frustrating that is wasn't addressed when it came up and I was young (in my 20s).

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@akeyfes

Asymptomatic. In fact as of last week I was doing an hour of hardcore cycling and heavy weightlifting 6 days a week. I am just in horror that I may have been literally risking my life with each rep. It is beyond frustrating that is wasn't addressed when it came up and I was young (in my 20s).

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The idea I may just drop dead randomly is really, really scaring the living day lights out of me…

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@akeyfes

The idea I may just drop dead randomly is really, really scaring the living day lights out of me…

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I bet! I can't imagine that weighing on your conscience every day. They do have different approaches for symptomatic versus asymptomatic patients.

Hybrid endovascular treatment for an asymptomatic Kommerell diverticulum at the right aortic arch – https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2816%2900263-9

This one is lengthy, but it is a Mayo Clinic Proceeding
https://www.mayoclinicproceedings.org/action/showPdf?pii=S0025-6196%2812%2960196-7
Were you able to make an appointment with the vascular surgeon to get a second opinion?

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@akeyfes

Hi, not sure if this is still active. I am going to see a specialist for unrelated issues and was going through old reports/data. I am 37 year old male and 10 years ago, doctor thought I had cancer and wanted to see if it spread so did a chest CT scan. It turned out to be false alarm and he was wrong and there was no cancer anywhere. I just looked at the report and actually read it where it mentions incidental finding of aberrant right subclavian artery stemming from diverculosis kommerell. The doctor never brought this up to me 10 years ago. I am in the process of setting up appointment with a vascular surgeon and would imagine I need current imaging. Have any of you have this? Is this something that you just live with and it's not an issue? What sort of lab work/imagining did you have on this? Did you put in stents? Any info on this would be much appreciated! There is really not much on the web about this.

Thank you!

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Hi!! So sorry to hear you had to go through all of this. I had aberrant right subclavian. I had surgery Nov 2019 at Mayo Rochester with Dr. Bower. My case is unique in the sense- i had no symptoms whatsoever. I also had no dilatation of the aberrant artery. I did have a large left subclavian aneurysm and descending aortic aneurysm. My cardiologist here in Florida sent me to Mayo right away, and with Dr. Bower and Dr. Pochettino help I had a 2 day surgery– day one Dr. Bower relocated my aberrant artery to my carotid( only because it was in the way for my aortic grafts I needed) and day 2 Dr. Pochettino replaced a large portion of my aorta and left subclavian. I highly recommend if you are needing a second opinion trying Mayo. Not many doctors know how to approach an aberrant artery. If your not having symptoms it may just require some routine imaging–mine was a Ct scan. I was told the main issue with this is the development of Kommeralls diverticulum– which is basically an aneurysm on the right subclavian-which doesn't happen all the time. Dr. Bower told me that if I did not need the aberrant artery moved because it was in the way of the graft for my other issues- he doubts my aberrant artery would have ever caused me any issues. I highly recommend before you panic to see a dr who is well experienced with this issue like Dr. Bower. It really did help me. Best wishes.

Jeane

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@jeanern01

Hi!! So sorry to hear you had to go through all of this. I had aberrant right subclavian. I had surgery Nov 2019 at Mayo Rochester with Dr. Bower. My case is unique in the sense- i had no symptoms whatsoever. I also had no dilatation of the aberrant artery. I did have a large left subclavian aneurysm and descending aortic aneurysm. My cardiologist here in Florida sent me to Mayo right away, and with Dr. Bower and Dr. Pochettino help I had a 2 day surgery– day one Dr. Bower relocated my aberrant artery to my carotid( only because it was in the way for my aortic grafts I needed) and day 2 Dr. Pochettino replaced a large portion of my aorta and left subclavian. I highly recommend if you are needing a second opinion trying Mayo. Not many doctors know how to approach an aberrant artery. If your not having symptoms it may just require some routine imaging–mine was a Ct scan. I was told the main issue with this is the development of Kommeralls diverticulum– which is basically an aneurysm on the right subclavian-which doesn't happen all the time. Dr. Bower told me that if I did not need the aberrant artery moved because it was in the way of the graft for my other issues- he doubts my aberrant artery would have ever caused me any issues. I highly recommend before you panic to see a dr who is well experienced with this issue like Dr. Bower. It really did help me. Best wishes.

Jeane

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Hi Jeane,

Thank you so much for the response. Is a vascular surgeon the right one to do this? Or cardio? Or thoracic? Or cardiothoracic? What made you go with a vascular surgeon?

Thank you,
Alex

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I’m happy to see this thread has some recent conversations. Clinic? I was found to have a right aortic arch with an aberrant left subclavian artery and Diverticulum of Kommerell on an MRI due to my cardiologist hearing a Brue. I’m 36, My cardiologist wasn’t concerned and said he would scan me again in a year which I’m due for now. I don’t know the size and when I asked at my appt the other week they said it wasn’t reported. I’m going to ask that they find out with this next scan. I was wondering what treatment options vs wait and see people have had. Is Mayo where the top physician’s for this are? I can’t even figure that out much less and kind of standard of care as the research is so lacking. Does anyone know if Mayo is doing any type of virtual consults right now. I live in MI and have a 1 and 3 yr old so traveling is not ideal right now.

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@akeyfes

Hi Jeane,

Thank you so much for the response. Is a vascular surgeon the right one to do this? Or cardio? Or thoracic? Or cardiothoracic? What made you go with a vascular surgeon?

Thank you,
Alex

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I had a consult first with Dr. Pochettino(cardio-vascular surgeon)-just because my main reason for going to Mayo was my tortuous aorta with aneurysms on my aorta and left subclavian–the aberrant artery was just a chance finding on the MRI. Dr. Pochettino is the one who set me up with Dr.Bower (the vascular surgeon). I would say if your issue is just the aberrant artery then vascular surgeon would be where to start ? But everyone at Mayo was so helpful and nice– I am positive if your case required another surgeon or dr. they would set all that up. I had almost like a case manager–she scheduled and set up all my appts. consults, labs, tests…she worked with each dr and had all of this set up before I even arrived at Mayo. So no going and seeing one dr. and being told I need to see another and come back. They take a very comprehensive and team approach. I had both surgeons and cardiologist already set up– I did all my test and saw the three drs all in the same day. My suggestion when you reach out initially is call the appt number, describe your problems, more than likely she will connect you to the office you need, and get the process started- if Mayo is where you choose to go.

Best wishes,
Jeane

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@jl2rogers

I’m happy to see this thread has some recent conversations. Clinic? I was found to have a right aortic arch with an aberrant left subclavian artery and Diverticulum of Kommerell on an MRI due to my cardiologist hearing a Brue. I’m 36, My cardiologist wasn’t concerned and said he would scan me again in a year which I’m due for now. I don’t know the size and when I asked at my appt the other week they said it wasn’t reported. I’m going to ask that they find out with this next scan. I was wondering what treatment options vs wait and see people have had. Is Mayo where the top physician’s for this are? I can’t even figure that out much less and kind of standard of care as the research is so lacking. Does anyone know if Mayo is doing any type of virtual consults right now. I live in MI and have a 1 and 3 yr old so traveling is not ideal right now.

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I went to Mayo for a few reasons. One my cardiologist was not familiar with treating aberrant artery, also I had many other anatomical issues that my dr and surgeon here did not feel comfortable treating ( and I highly respect that both were honest enough with me to tell me that–instead of trying to treat me and risk my health). Mayo has an affiliation with our hospital- so it was the best place for me to start. I got an appt there quickly- within a month, and in the time before that–spoke to Dr. Dearni over the phone. I was scheduled for surgery a little over a month later. As for Mayo having the top physicians– I feel they do. Dr. Pochettino had only a few minutes-due to being called away for an emergent surgery- but he pulled up my scan–in a matter of minutes told me confidently a plan- he told me he had only seen maybe five patients with similar anatomical issues such as me–but that the surgery to fix my problems was one he had done many, many times. And he said because of his experience with working mainly with the aorta- he wanted to do surgery now. Thats what makes Mayo better in my opinion–they see the most uncommon problems on a regular basis–because like me–many of the patients are referred to them from all over the world. Also their surgeons have a focus–Dr. Pochettino was a cardiosurgeon who focused on aorta-so that's who i was initially referred to. He does many of his ARSA surgeries with Dr.Bower. I imagine there must be some type of virtual appts. I was supposed to go there to meet with Dr.Bower for my year follow up for my ARSA surgery. I was able to get my scans here in Florida, mail them to Dr.Bower and the office called me and basically did the follow up over the phone. This is the most organized medical facility I have been to– I am a nurse and my husband a physician– both of us where amazed at how well Mayo operated. I don't know if I was able to help answer any of your questions….

Best Wishes,
Jeane

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