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Esophageal compression by the aorta after arterial switch
D B McElhinney1, V M Reddy, G P Reddy
1Department of Radiology, University of California, San Francisco, USA.
Insights
Severe esophageal compression in a child, initially treated with aortopexy after arterial switch operation, resolved with esophageal transposition. This surgical approach offers a lasting solution for extrinsic esophageal compression.
Area of Science:
- Pediatric Surgery
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Extrinsic esophageal compression in children typically results from congenital vascular rings.
- Acquired extrinsic esophageal compression can occur secondary to cardiovascular surgical interventions.
Observation:
- A patient developed severe esophageal compression requiring gastrostomy tube feeding years after an arterial switch operation.
- Initial surgical interventions, including aortopexy and mediastinal mobilization, provided only transient relief.
Findings:
- Recurrent esophageal compression after initial surgical management was successfully treated with esophageal transposition.
- Transposing the esophagus to the right thoracic cavity achieved lasting symptom resolution.
Implications:
- Esophageal transposition is a viable surgical option for managing complex, recurrent extrinsic esophageal compression in pediatric patients post-cardiac surgery.
- This case highlights the importance of considering esophageal repositioning for refractory extrinsic esophageal compression.
Abstract:
Extrinsic compression of the esophagus in children most often occurs in the presence of a congenital vascular ring. We recently operated on a patient in whom esophageal compression had developed that was severe enough to require feeding via a gastrostomy tube several years after the arterial switch operation. Aortopexy and extensive mediastinal mobilization were performed twice with transient relief and gradual return of symptoms. Almost 3 years after the first aortopexy, lasting relief was achieved by transposing the esophagus into the right side of the chest.