Related Experiment Videos
Vascular anomalies causing tracheoesophageal compression: a 20-year experience in diagnosis and management
Mustafa Yilmaz1, Murat Ozkan, Riza Dogan
1Department of Thoracic and Cardiovascular Surgery, Hacettepe University, Ankara, Turkey. myilmazmd88@hotmail.com
Insights
Surgical correction of congenital aortic arch anomalies, or vascular rings, effectively treats tracheoesophageal obstruction in children. This approach offers low mortality and morbidity rates, with most patients experiencing symptom resolution.
Area of Science:
- Pediatric Surgery
- Congenital Heart Surgery
- Thoracic Surgery
Background:
- Congenital aortic arch anomalies, including vascular rings, are significant causes of tracheoesophageal obstruction in pediatric patients.
- These anomalies can lead to severe respiratory and swallowing difficulties.
Purpose of the Study:
- To report the diagnostic methods, surgical treatment, and outcomes for children with tracheoesophageal compression due to aortic arch anomalies.
- To evaluate the efficacy and safety of surgical correction for these conditions.
Main Methods:
- A retrospective review of 30 pediatric patients who underwent surgery for aortic arch anomalies between 1982 and 2002.
- Diagnosis was confirmed using barium esophagogram, CT, MRI, and angiography.
- Surgical repair was performed via left thoracotomy or median sternotomy.
Main Results:
- Double aortic arch was the most common anomaly (53.3%).
- The operative mortality rate was 3.3%.
- At long-term follow-up (mean 34 weeks), 86.7% of patients were symptom-free, 10% had residual respiratory issues, and 3.3% had gastroesophageal reflux.
Conclusions:
- Surgical correction of symptomatic vascular rings and related aortic arch anomalies is associated with low mortality.
- The procedure demonstrates favorable early and late outcomes, with significant symptom improvement in the majority of pediatric patients.
Background:
Vascular rings and other congenital aortic arch anomalies may be major causes of tracheoesophageal obstruction in children. In this report, our diagnostic approach, surgical treatment, and early and late results for 30 patients are reported.
Methods:
During a 20-year period (1982-2002), 30 children underwent surgery for tracheoesophageal compression caused by aortic arch anomalies. The median age at operation was 8 months (range, 36 days to 94 months), and the median patient weight was 8 kg (range, 2.4-16 kg). At 53.3% of cases, double aortic arch was by far the most common encountered cause of compression. Patients were admitted with respiratory distress, stridor, apnea, dysphagia, or recurrent respiratory tract infections. Diagnosis was established by barium esophagogram, computed tomography, magnetic resonance imaging, and angiography. The operative approaches were through a left thoracotomy or a median sternotomy.
Results:
Operative mortality rate was 3.3%. Follow-up data from 2 months to 10 years (mean follow-up, 34 weeks) were available for all 30 patients. Twenty-six patients (86.7%) were essentially free of symptoms, 3 patients (10%) had residual respiratory problems, and 1 patient (3.3 %) had a gastroesophageal reflux problem.
Conclusion:
These results suggest that surgical correction of symptomatic vascular rings can be performed with low mortality and morbidity rates.