Tracheal Compression Caused by a Mediastinal Hematoma After Interrupted Aortic Arch Surgery

Area of Science:

• Cardiology
• Thoracic Surgery
• Pediatric Surgery

Background:

• Congenital aortic arch abnormalities, including interrupted aortic arch (IAA), coarctation of the aorta (CoA), and double aortic arch (DAA), often require complex surgical repair.
• Postoperative complications following aortic arch repair are frequent, with tracheobronchial stenosis and respiratory insufficiency being uncommon but severe issues.

Observation:

• This report details a rare case of tracheal compression in a patient following interrupted aortic arch surgery.
• The compression was caused by a mediastinal hematoma, a complication often overlooked in favor of anastomotic tension as the primary cause of airway issues.

Findings:

• The patient presented with severe symptoms of respiratory insufficiency due to tracheal compression by a mediastinal hematoma.
• Surgical evacuation of the hematoma led to successful weaning from the ventilator, resolving the airway obstruction.

Implications:

• Mediastinal hematoma should be considered in the differential diagnosis of tracheobronchial stenosis after aortic arch surgery, even when anastomotic tension is suspected.
• Prompt recognition and management of mediastinal hematomas are crucial for improving patient outcomes and preventing severe respiratory compromise.