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Abstract

Drs Kosloske and Jewell highlighted in their letter the usefulness of tracheobronchoscopy in diagnosing right-sided aortic arch in infants with esophageal atresia/tracheoesophageal fistula (EA/TEF). In the letter they state that “dominant pulsations” at the midtracheal level were identified in 75% of their infants with EA/TEF and always corresponded to the side of the arch at thoracotomy. However, in the original article 1 Kosloske AM Jewell PF Cartwright KC Crucial bronchoscopic findings in esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. 1988; 23: 466-470 Abstract Full Text PDF PubMed Scopus (46) Google Scholar these authors evaluated the position of the aortic arch at bronchoscopy only in 13 of 42 infants, and found right-sided aortic pulsation in only one patient who had right aortic arch. The side of dominant pulsation could not be determined in 3 of these infants, one of whom had a double arch. Interestingly, in our recent series of aortic arch anomalies in infants with EA/TEF 2 Babu R Pierro A Spitz L et al. The management of oesophageal atresia in neonates with right-sided aortic arch. J Pediatr Surg. 2000; 35: 56-58 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar we reported 9 infants with right-sided aortic arch and 3 (25%) with double aortic arch. We do not believe that the data of Dr Kosloske et al 1 Kosloske AM Jewell PF Cartwright KC Crucial bronchoscopic findings in esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. 1988; 23: 466-470 Abstract Full Text PDF PubMed Scopus (46) Google Scholar provide sufficient evidence to support the value of tracheobronchoscopy for the diagnosis of aortic arch anomalies in infants with EA/TEF.