Treatment solution by Omura et al.

A 53-year old man without significant medical history was admitted to our hospital due to sudden onset chest pain. Contrast-enhanced computed tomography revealed acute type A aortic dissection with a right aortic arch and an aberrant left subclavian artery arising from Kommerell diverticulum (Fig. 1). Aortic dissection involved the ascending aorta only and did not reach the supra-aortic vessels. Arch branches arose in the following order: left common carotid artery, right common carotid artery, right subclavian artery and left subclavian artery. The origin of the aberrant left subclavian artery was located behind the trachea and esophagus. The cross-sectional diameter at the origin of the aberrant subclavian artery from the aortic arch and from the opposite aortic wall to the tip of the Kommerell diverticulum was 27 and 61 mm, respectively. The treatment of choice for ‘Acute type A aortic dissection in a patient with right aortic arch and an aberrant left subclavian artery arising from Kommerell diverticulum’ is revealed below.