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[Aortic uncrossing for compressive circumflex aorta. 3 cases].

C Planché, F Lacour-Gayet

    Presse Medicale (Paris, France : 1983)
    |May 19, 1984
    PubMed
    Summary
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    A rare congenital heart defect, circumflex aorta, can compress the airway in children. Surgical uncrossing and reimplantation of the aorta effectively relieved tracheobronchial compression in three pediatric patients.

    Area of Science:

    • Cardiovascular Surgery
    • Pediatric Cardiology
    • Thoracic Surgery

    Background:

    • Circumflex aorta is a rare congenital anomaly where the aortic arch arises from the descending aorta and arches to the right.
    • Tracheobronchial compression can occur secondary to vascular rings, including circumflex aorta, leading to respiratory distress in infants and children.

    Observation:

    • Three pediatric patients presented with symptoms suggestive of tracheobronchial compression attributed to a circumflex aorta.
    • Initial attempts to alleviate compression by dividing the arterial ligament were unsuccessful.
    • Endoscopic examination revealed severe extrinsic compression of the trachea and tracheal bifurcation directly by the aberrant aortic arch.

    Findings:

    • A surgical technique involving median sternotomy was employed to access and mobilize the aortic arch.

    Related Experiment Videos

  • The aorta was transected below the right carotid artery origin, de-rotated (uncrossed), and reimplanted onto the ascending aorta.
  • The procedure utilized deep hypothermia and cardiopulmonary bypass for cerebral protection during aortic reconstruction.

    • Implications:

    • This surgical approach effectively resolved tracheobronchial compression caused by circumflex aorta in the studied pediatric cohort.
    • The findings suggest that aortic uncrossing and reimplantation is a viable and effective treatment for symptomatic circumflex aorta causing airway obstruction.
    • This strategy offers a potential solution for complex congenital cardiovascular anomalies presenting with significant respiratory compromise.