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Airway function in infants with vascular rings: preoperative and postoperative assessment
A H Thomson1, C S Beardsmore, R Firmin
1Department of Child Health, University of Leicester.
Insights
Infants with aortic arch anomalies causing airway obstruction show improved breathing after surgery. However, some airway abnormalities may persist, indicating ongoing tracheal dynamics issues.
Area of Science:
- Pediatric Cardiology
- Respiratory Medicine
- Thoracic Surgery
Background:
- Aortic arch anomalies are a common cause of airway obstruction in infants.
- Early diagnosis and intervention are crucial for managing these conditions.
Purpose of the Study:
- To assess airway function in infants with aortic arch anomalies using plethysmography and flow-volume loops.
- To evaluate the effectiveness of surgical correction on airway function.
Main Methods:
- Six symptomatic infants underwent airway function assessment.
- Techniques included plethysmography and chest compression for partial flow-volume loops.
- Airway resistance (Raw) and maximum flow rates (VmaxFRC) were measured pre- and post-operatively.
Main Results:
- Four infants with complete vascular rings (double aortic arch, pulmonary sling) had significantly increased Raw and decreased VmaxFRC.
- Postoperative assessment showed substantial improvement in Raw and VmaxFRC.
- Flow-volume loop shape abnormalities persisted in the early postoperative period.
Conclusions:
- Aortic arch anomalies significantly impair infant airway function.
- Surgical repair improves airway obstruction but may not fully normalize tracheal dynamics.
- Continued monitoring of airway function post-surgery is recommended.
Abstract:
Aortic arch anomalies in infancy often cause intrathoracic airway obstruction. Airway function was assessed as part of the diagnostic evaluation in six symptomatic infants both by plethysmography and using a chest compression technique to obtain partial flow-volume loops. Two infants had normal intrathoracic airway function and their symptoms were unrelated to aortic arch abnormalities. The remaining four had complete vascular rings (three double aortic arch, one pulmonary sling) and had increased expiratory airway resistance (Raw) (mean Raw = 700% predicted) and greatly decreased maximum flow rates at functional residual capacity (VmaxFRC; mean VmaxFRC = 34% predicted) with gross shape abnormalities of the flow-volume loop. Postoperatively airway function was substantially improved (mean Raw = 175% predicted, VmaxFRC = 79% predicted) but some abnormality of flow-volume loop shape remained, suggesting that tracheal dynamics were not completely normal in the early postoperative period.