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Double aortic arch causing tracheoesophageal compression

M T Han1, D G Hall, A Manché

  • 1Department of Cardiovascular Surgery, Children's Hospital and Medical Center, Seattle, Washington 98105.

American Journal of Surgery
|May 1, 1993
PubMed

Insights

Surgical repair of double aortic arch in 17 pediatric patients effectively resolved respiratory and swallowing issues. Early intervention before 24 months improved outcomes, with no mortality and complete symptom resolution in all cases.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Thoracic Surgery
  • Congenital Heart Disease

Background:

  • Double aortic arch is a rare congenital vascular anomaly causing extrinsic compression of the trachea and esophagus.
  • Symptoms often manifest in infancy, including respiratory distress and feeding difficulties.

Purpose of the Study:

  • To review the surgical management and outcomes of patients with double aortic arch treated at a single institution.
  • To evaluate the efficacy of surgical intervention in alleviating symptoms associated with this condition.

Main Methods:

  • Retrospective review of 17 patients surgically treated for double aortic arch since 1972.
  • Diagnostic modalities included barium swallow and bronchoscopy to assess esophageal and tracheal compression.
  • Surgical techniques involved division of the dominant arch, resection of Kommerell's diverticulum when present, and vascular suspension for tracheal/esophageal release.

Main Results:

  • All 17 patients underwent successful surgical correction, with 16 having the anterior arch divided and one the posterior arch.
  • 11 patients required surgery before 12 months of age, and 16 before 24 months.
  • Four patients had Kommerell's diverticulum resected; 13 required vascular suspension.
  • Complete symptomatic improvement was achieved in all patients, with no mortality.
  • Four patients experienced residual symptoms potentially due to tracheomalacia.

Conclusions:

  • Surgical correction of double aortic arch is highly effective in treating pediatric patients with symptomatic vascular rings.
  • Early surgical intervention is crucial for optimal outcomes.
  • While generally curative, residual symptoms may occur, possibly related to associated tracheomalacia.

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