{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T06:31:57Z","timestamp":1764916317100,"version":"3.46.0"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"\n Background<\/jats:title>\n Kommerell's diverticulum (KD) with vascular rings is an uncommon cause of pediatric airway and feeding symptoms, and data from the Arab region are scarce. We report a Palestinian cohort of all diagnosed and managed cases, describing presentation, diagnostics, and management.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively studied all children at Al-Makassed Hospital (Jerusalem) from 2016 to 2024 who were diagnosed with vascular rings\u2009+\u2009KD confirmed by imaging or intra-operative findings. We abstracted demographics, symptoms, test performance, anatomy, treatments, and peri-operative course and follow-up. Primary outcomes were diagnostic yield and improvement at last visit.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Fourteen patients were included; median age at diagnosis was 8 months (IQR 2\u201315), symptom onset 15 days (0\u201383). Thirteen (92.9%) were symptomatic; stridor (64.3%), recurrent wheeze (35.7%), and dysphagia\/choking (28.6%) predominated; 42.9% had prior misdiagnoses. Barium swallow was positive in 7\/8 (87.5%), echocardiography in 5\/9 (55.6%), bronchoscopy in 10\/12 (83%), and CT angiography (CTA) confirmed anatomy in 13\/13 (100%). Anatomy included right aortic arch (RAA) with aberrant left subclavian artery in 8\/14 (57.1%), double aortic arch in 4\/14 (28.6%), and innominate artery compression in 2\/14 (14.3%); 57.1% had minor intracardiac anomalies. Thirteen children (92.9%) underwent surgery (ligamentum division, diverticulectomy\u2009\u00b1\u2009subclavian transfer, aortopexy, or double-arch division); one mild innominate compression case was observed. All were discharged alive; one late death occurred. At last follow-up, 7\/13 survivors were asymptomatic and 6\/13 had residual but improved symptoms. Median hospital stay was 18 days (IQR 7\u201325).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n KD-associated rings present early yet are frequently delayed in diagnosis. CTA is definitive, and tailored surgery yields meaningful, often complete, symptom relief with acceptable morbidity.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fped.2025.1713368","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T06:25:29Z","timestamp":1764915929000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["From stridor to symptom relief; management of pediatric Kommerell's diverticulum and vascular rings in Palestine [2016\u20132024]: a single center cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Mohammad","family":"Amouri","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salahaldeen","family":"Deeb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nour","family":"Sourkhi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Qasim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boshra","family":"Abu Hadeed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalil Omar","family":"Atatra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Nasereddin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"25","DOI":"10.3390\/jcdd8030025","article-title":"The clinical spectrum of Kommerell\u2019s diverticulum in adults with a right-sided aortic arch: a case series and literature overview","volume":"8","author":"Van Rosendael","year":"2021","journal-title":"J Cardiovasc Dev Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1745","DOI":"10.1016\/j.athoracsur.2019.04.122","article-title":"Outcomes of repair of Kommerell diverticulum","volume":"108","author":"Vinnakota","year":"2019","journal-title":"Ann Thorac Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"313","DOI":"10.14740\/jmc3930","article-title":"Two patients with difficulty in swallowing due to dysphagia lusoria","volume":"13","author":"Ugonabo","year":"2022","journal-title":"J Med Cases"},{"key":"B4","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1007\/s11748-015-0521-3","article-title":"Kommerell\u2019s diverticulum in the current era: a comprehensive review","volume":"63","author":"Tanaka","year":"2015","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1007\/s11606-024-08672-3","article-title":"Kommerell\u2019s diverticulum","volume":"39","author":"Kakimoto","year":"2024","journal-title":"J Gen Intern Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1016\/j.jvs.2023.01.014","article-title":"Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell\u2019s diverticulum","volume":"77","author":"Bath","year":"2023","journal-title":"J Vasc Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2333794X19897506","DOI":"10.1177\/2333794(19897506","article-title":"Kommerell\u2019s diverticulum with a twist: a case of recurrent wheeze in an 8-year-old boy","volume":"6","author":"Robles","year":"2019","journal-title":"Glob Pediatr Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1016\/j.jtcvs.2004.10.044","article-title":"Trends in vascular ring surgery","volume":"129","author":"Backer","year":"2005","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1016\/j.ejcts.2006.12.038","article-title":"Subclavian flap aortoplasty: still a safe, reproducible, and effective treatment for infant coarctation","volume":"31","author":"Barreiro","year":"2007","journal-title":"Eur J Cardiothorac Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1016\/j.athoracsur.2019.06.076","article-title":"Contemporary midterm outcomes in pediatric patients undergoing vascular ring repair","volume":"109","author":"Binsalamah","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.ijporl.2006.08.025","article-title":"The presentation and management of vascular rings: an otolaryngology perspective","volume":"71","author":"Shah","year":"2007","journal-title":"Int J Pediatr Otorhinolaryngol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1713368\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T06:25:29Z","timestamp":1764915929000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1713368\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":11,"alternative-id":["10.3389\/fped.2025.1713368"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1713368","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]},"article-number":"1713368"}}