Tracheal compression by the aortic arch following right pneumonectomy in infancy

Uneventful pneumonectomy was carrried out in a 10-month-old infant for hypoplastic right lung associated with esophageal origin of the right main bronchus. Eight months after operation, symptoms of tracheal compression began. This compression was due to the aortic arch, which was stretched across the lower trachea following the displacement of the heart to the posterior right chest after pneumonectomy. Successful relief of the airway obstruction was achieved by inserting a 20 mm woven Dacron graft between the ascending and the descending aorta, with division of the aortic arch between the left carotid and the left subclavian arteries. An aortogram performed two years after operation confirmed good patency of the graft and normal flow through the descending aorta. The child remains well two years after operation but continues to have mild residual tracheomalacia and limited exercise tolerance, compatible with the presence of only one lung.