Aortic Uncrossing for Iatrogenic Circumflex Aorta Associated With Left Mainstem Bronchial Compression

Double aortic arch is a rare congenital malformation requiring surgical intervention. Initial vascular ring division is typically successful but can create an iatrogenic circumflex aorta that may require complex reoperation.

A 5-month-old boy with double aortic arch developed worsening respiratory symptoms after division of the nondominant left-sided arch, causing leftward migration of the descending aorta and creating an iatrogenic circumflex aorta with bronchial compression. A comprehensive aortic uncrossing procedure was performed using dual arterial cannulation, repositioning the descending aorta beneath the carina, with symptom resolution.

This case emphasizes a rare complication of vascular ring division. Careful evaluation of potential postoperative aortic migration is essential, as initial intervention may create iatrogenic circumflex aorta. Our technique provides optimal airway decompression while avoiding deep hypothermic circulatory arrest.

Recognition of potential iatrogenic circumflex aorta after initial vascular ring division is crucial. A comprehensive aortic uncrossing procedure offers an effective solution.