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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 725-731, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
CL Backer, MN Ilbawi, FS Idriss and SY DeLeon
Two hundred four infants and children (mean age 13 months) have undergone
operation for the relief of tracheoesophageal obstruction resulting from
vascular anomalies. One hundred thirteen patients had complete vascular
rings (group I), 61 with double aortic arch and 52 with right aortic arch
with a left ligamentum. Nine patients had a pulmonary artery sling (group
II), 71 had innominate artery compression (group III), and 11 had
miscellaneous anomalies (group IV). Patients were admitted with respiratory
distress, stridor, apnea, dysphagia, or recurrent respiratory infections.
Diagnosis was established by barium esophagogram in group I; barium
esophagogram, bronchoscopy, and computed tomography or angiography in group
II; bronchoscopy in group III; and barium esophagogram or angiography in
group IV. The operative approach was through a left thoracotomy in group I,
II and IV (93% of these patients) and through a right thoracotomy for group
III (96% of these patients). The operative mortality rate was 4.9% and
there were seven late deaths (3.4%). There have been no operative deaths in
patients with isolated vascular anomalies in the past 28 years. Follow- up
data from 1 month to 20 years (mean 8.5 months) were available on 159
patients; 141 (92%) were essentially free of symptoms, and 12 (8%) had
residual respiratory problems. Five of six patients in group II having a
lung scan postoperatively had a patent left pulmonary artery. A strong
index of suspicion is necessary to avoid the complications of vascular
rings in children. Barium swallow is the best single diagnostic technique
for patients with complete vascular rings. A bronchoscopic study is
required to diagnose innominate artery compression. Angiograms or computed
tomographic scans are used to confirm the diagnosis of pulmonary artery
sling. Left thoracotomy provides excellent exposure for all vascular rings
except the displaced innominate artery, for which a right thoracotomy is
the best approach.
ARTICLES
Vascular anomalies causing tracheoesophageal compression. Review of experience in children
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, IL 60614.
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