Emergency surgery for neonatal double aortic arch complicated with severe tracheal stenosis under prenatal ultrasound guidance

Abstract

Children often require surgery for compression of the vascular ring formed by a double aortic arch on the trachea or oesophagus. We report a case of a 3 kg infant with dyspnoea requiring endotracheal intubation immediately after birth. Foetal ultrasound suggested a double aortic arch and tracheal stenosis (Panels A and B; 31 weeks + 5 day of gestation, vascular ring, 1 mm inner diameter of the main trachea). We made a definite diagnosis (Panels C and D) and rapidly corrected the double aortic arch 3 days after birth. Endotracheal intubation was withdrawn 1 day after surgery, and the infant was discharged on day 9. Good growth was observed at the 11-month follow-up. This is the first case report and the youngest child to undergo correction of a double aortic arch. We concluded the following: (i) A double aortic arch can cause very severe tracheal stenosis, which requires surgery during the neonatal period. (ii) Prenatal foetal ultrasound monitoring of tracheal diameter is of guiding significance for the diagnosis of and surgery for tracheal stenosis. Attention should be paid to the tracheal measurement in foetuses with macrovascular malformations. (iii) An accurate prenatal ultrasound examination avoids delaying the treatment of critically ill infants.