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Right-sided aortic arch presenting as refractory intraoperative and postoperative wheezing
S Bose1, T S Hurst, D W Cockcroft
1University Hospital, Department of Medicine, Saskatoon, Saskatchewan, Canada.
Chest
|May 1, 1991
Summary
A rare right-sided aortic arch caused severe breathing difficulties during surgery. Symptoms improved when the patient was moved and fluids were adjusted, highlighting a positional airway obstruction.
Area of Science:
- Cardiology
- Thoracic Surgery
- Anesthesiology
Background:
- Intraoperative respiratory complications can significantly impact patient outcomes.
- Anatomical variations, such as aortic arch anomalies, may present unique anesthetic challenges.
Observation:
- A 29-year-old woman experienced severe, refractory intraoperative wheezing and airflow limitation.
- Symptoms resolved spontaneously, prompting further investigation.
- Contrast-enhanced computed tomographic (CT) scan revealed a right-sided aortic arch.
Findings:
- Flow-volume studies demonstrated variable intrathoracic large airway obstruction.
- Airway obstruction worsened significantly in the supine position.
- Intravascular volume expansion slightly exacerbated the obstruction.
Implications:
- A right-sided aortic arch can cause dynamic airway obstruction, particularly in the intraoperative setting.
- Anesthetic management should consider potential positional airway compression in patients with aortic arch anomalies.
- Early recognition and appropriate positioning are crucial for managing such cases.