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Mediastinal vascular anomalies causing tracheal and esophageal compression and obstruction in childhood

W T MUSTARD, A W TRIMBLE, G A TRUSLER

    Canadian Medical Association Journal
    |December 22, 1962
    PubMed

    Insights

    This study reviewed 22 pediatric surgeries for vascular compression of the trachea and esophagus, identifying common causes like double aortic arch. Careful pre- and post-operative care is crucial for these serious cases.

    Area of Science:

    • Pediatric Surgery
    • Thoracic Surgery
    • Vascular Anomalies

    Background:

    • Vascular compression of the trachea and esophagus in children can lead to severe respiratory and swallowing difficulties.
    • Congenital anomalies of the aortic arch are a significant cause of such compressions.
    • Surgical intervention is often necessary to alleviate symptoms and prevent long-term complications.

    Purpose of the Study:

    • To review surgical outcomes for pediatric patients with vascular compression of the airway and esophagus.
    • To identify the common vascular anomalies causing these compressions.
    • To highlight the importance of perioperative management in improving patient survival.

    Main Methods:

    • Retrospective review of 22 pediatric cases operated for vascular compression over 11 years.
    • Classification of vascular anomalies including double aortic arch, right aortic arch with left ligamentum arteriosum, anomalous innominate artery, and aberrant right subclavian artery.
    • Analysis of surgical outcomes, complications, and mortality.

    Main Results:

    • 22 children underwent surgery for vascular compression.
    • The most frequent anomaly was double aortic arch (13 cases).
    • One unusual case of right aortic arch, aberrant left subclavian artery, and left ligamentum arteriosum was reported.
    • Mortality rate was 18% (4 deaths), with one intraoperative death during intubation and three postoperative deaths despite tracheotomy.

    Conclusions:

    • Vascular compression of the trachea and esophagus in children presents significant surgical challenges.
    • Careful preoperative and postoperative management is essential for improving outcomes.
    • Avoiding tracheotomy when possible may reduce postoperative complications and mortality.

    Keywords:
    AORTIC DISEASESESOPHAGEAL STENOSISHEART DEFECTS, CONGENITALPULMONARY ARTERYSUBCLAVIAN ARTERYTRACHEAL STENOSIS

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