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Tracheoesophageal compression from aortic arch anomalies: analysis of 30 operatively treated children
C S Roberts1, H B Othersen, R M Sade
1Department of Surgery, Medical University of South Carolina, Charleston 29425.
Insights
This study found no mortality in 30 children treated surgically for aortic arch anomalies causing tracheoesophageal compression. Surgical interventions for these vascular rings were effective, with low reoperation rates.
Area of Science:
- Cardiology
- Pediatric Surgery
- Thoracic Surgery
Background:
- Aortic arch anomalies can cause tracheoesophageal compression in children.
- Surgical management is crucial for symptomatic cases.
Purpose of the Study:
- To review surgical outcomes for pediatric patients with tracheoesophageal compression due to aortic arch anomalies.
- To analyze different types of anomalies and surgical approaches.
Main Methods:
- Retrospective review of 30 pediatric patients undergoing surgery for aortic arch anomalies between 1976 and 1992.
- Analysis of patient demographics, anomaly types, surgical procedures, and outcomes.
Main Results:
- No in-hospital or 30-day mortality was observed.
- Common anomalies included double aortic arch and aberrant subclavian arteries.
- Reoperation was needed in 13% of cases, typically for aortopexy or tracheopexy.
Conclusions:
- Surgical correction of aortic arch anomalies causing tracheoesophageal compression is safe and effective in children.
- Early surgical intervention can prevent mortality and reduce the need for reoperation.
Abstract:
During a 16-year period (1976 to 1992), 30 children underwent surgery for tracheoesophageal compression caused by aortic arch anomalies. The age range was 3 days to 12 years (median, 3 months); 19 (63%) were male, and 20 (67%) were white. Of the 30 patients, 10 had a double aortic arch (the left was atretic in 6), 5 had a left-sided arch with an aberrant right subclavian artery (4) or innominate artery (1), and 15 had a right-sided arch with an aberrant left subclavian artery (14) or with mirror-image branching (1). There was no mortality during hospitalization or within 30 days of surgery. The left ductus arteriosus was divided in 26 of the 30 patients. Among the 10 patients with a double aortic arch, division of the atretic left arch (6), the lesser left arch (3), or the lesser right arch (1) was carried out. All 4 patients with a left arch and aberrant right subclavian artery had division of the artery. Of 14 patients with a right arch and aberrant left subclavian artery, only 3 underwent division of the artery. Of the 30 patients, anterior arteriopexy was performed in 9 (30%), and reoperation for persistent symptoms was necessary in 4 (13%). The second operation usually consisted of aortopexy or tracheopexy. Of the 4 patients with associated cardiac anomalies, 2 underwent simultaneous cardiac repair. The duration of hospital stay for the 30 patients ranged from 4 to 148 days (median, 6 days). Excluded from this series are patients with vascular rings who were asymptomatic and patients with the pulmonary vascular sling syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)