Aortic arch uncrossing using a tracheal resection procedure

Area of Science:

• Cardiovascular Surgery
• Pediatric Surgery
• Thoracic Surgery

Background:

• Right aortic arch with Kommerell's diverticulum is a rare congenital anomaly causing vascular rings.
• These anomalies can lead to significant compression of the trachea and esophagus, resulting in respiratory and swallowing difficulties.

Observation:

• A 10-month-old patient presented with recurrent respiratory symptoms due to residual compression from a right aortic arch and Kommerell's diverticulum after initial surgery.
• CT scans and airway endoscopy revealed persistent tracheal compression and tracheomalacia in the affected segment.

Findings:

• Initial surgical intervention (anterior arch division and posterior aortopexy) provided only temporary relief.
• A second surgical procedure involving resection of the tracheomalacic trachea and anterior translocation of the aortic arch was performed.

Implications:

• This case highlights the complexity of managing symptomatic vascular rings, particularly those with associated tracheomalacia.
• Surgical translocation of the aortic arch anterior to the airway may be a viable option for relieving persistent compression and improving outcomes in select pediatric patients.