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Vascular anomalies causing tracheoesophageal compression. Review of experience in children
C L Backer1, M N Ilbawi, F S Idriss
1Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, IL 60614.
Insights
Surgical relief of tracheoesophageal obstruction from vascular anomalies in children is effective. Most patients experienced symptom resolution after operations for vascular rings and related conditions.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Anomalies
Background:
- Vascular anomalies can cause tracheoesophageal obstruction in infants and children.
- Symptoms include respiratory distress, stridor, apnea, dysphagia, and recurrent infections.
Purpose of the Study:
- To review surgical outcomes for tracheoesophageal obstruction due to vascular anomalies.
- To evaluate diagnostic methods and surgical approaches for different types of vascular anomalies.
Main Methods:
- Retrospective review of 204 infants and children undergoing surgery for vascular anomalies.
- Diagnosis utilized barium esophagogram, bronchoscopy, CT, and angiography.
- Surgical approaches included left or right thoracotomy.
Main Results:
- Operative mortality was 4.9%, with no deaths in isolated anomaly cases in 28 years.
- 92% of 159 followed patients were symptom-free; 8% had residual issues.
- Barium swallow is key for vascular rings; bronchoscopy for innominate artery compression; CT/angiography for pulmonary artery sling.
Conclusions:
- Surgical intervention for tracheoesophageal obstruction from vascular anomalies yields good long-term results.
- Accurate diagnosis and appropriate surgical approach are crucial for successful outcomes.
- Early suspicion and diagnosis can prevent complications of pediatric vascular rings.
Abstract:
Two hundred four infants and children (mean age 13 months) have undergone operation for the relief of tracheoesophageal obstruction resulting from vascular anomalies. One hundred thirteen patients had complete vascular rings (group I), 61 with double aortic arch and 52 with right aortic arch with a left ligamentum. Nine patients had a pulmonary artery sling (group II), 71 had innominate artery compression (group III), and 11 had miscellaneous anomalies (group IV). Patients were admitted with respiratory distress, stridor, apnea, dysphagia, or recurrent respiratory infections. Diagnosis was established by barium esophagogram in group I; barium esophagogram, bronchoscopy, and computed tomography or angiography in group II; bronchoscopy in group III; and barium esophagogram or angiography in group IV. The operative approach was through a left thoracotomy in group I, II and IV (93% of these patients) and through a right thoracotomy for group III (96% of these patients). The operative mortality rate was 4.9% and there were seven late deaths (3.4%). There have been no operative deaths in patients with isolated vascular anomalies in the past 28 years. Follow-up data from 1 month to 20 years (mean 8.5 months) were available on 159 patients; 141 (92%) were essentially free of symptoms, and 12 (8%) had residual respiratory problems. Five of six patients in group II having a lung scan postoperatively had a patent left pulmonary artery. A strong index of suspicion is necessary to avoid the complications of vascular rings in children. Barium swallow is the best single diagnostic technique for patients with complete vascular rings. A bronchoscopic study is required to diagnose innominate artery compression. Angiograms or computed tomographic scans are used to confirm the diagnosis of pulmonary artery sling. Left thoracotomy provides excellent exposure for all vascular rings except the displaced innominate artery, for which a right thoracotomy is the best approach.