Tracheoesophageal compression from aortic arch anomalies: Analysis of 30 operatively treated children

Abstract

During a 16-year period (1976 to 1992), 30 children underwent surgery for tracheoesophageal compression caused by aortic arch anomalies. The age range was 3 days to 12 years (median, 3 months); 19 (63%) were male, and 20 (67%) were white. Of the 30 patients, 10 had a double aortic arch (the left was atretic in 6), 5 had a left-sided arch with an aberrant right subclavian artery (4) or innominate artery (1), and 15 had a right-sided arch with an aberrant left subclavian artery (14) or with mirror-image branching (1). There was no mortality during hospitalization or within 30 days of surgery. The left ductus arteriosus was divided in 26 of the 30 patients. Among the 10 patients with a double aortic arch, division of the atretic left arch (6), the lesser left arch (3), or the lesser right arch (1) was carried out. All 4 patients with a left arch and aberrant right subclavian artery had division of the artery. Of 14 patients with a right arch and aberrant left subclavian artery, only 3 underwent division of the artery. Of the 30 patients, anterior arteriopexy was performed in 9 (30%), and reoperation for persistent symptoms was necessary in 4 (13%). The second operation usually consisted of aortopexy or tracheopexy. Of the 4 patients with associated cardiac anomalies, 2 underwent simultaneous cardiac repair. The duration of hospital stay for the 30 patients ranged from 4 to 148 days (median, 6 days). Excluded from this series are patients with vascular rings who were asymptomatic and patients with the pulmonary vascular sling syndrome. Airway obstruction from congenital vascular rings was relieved at the initial operation in 87% of patients and was associated with no mortality. Reoperation is more likely to be necessary when severe tracheomalacia is present and might be avoided by arteriopexy or tracheopexy at the initial operation, guided by endoscopy. This series emphasizes that congenital vascular rings do not produce cardiovascular problems. The difficulties are the result of airway compression.