Original article: cardiovascularVascular anomalies and tracheoesophageal compression: a single institution’s 25-year experience
Section snippets
Patients and methods
We retrospectively reviewed the charts of 82 patients with symptomatic compression of the trachea or esophagus secondary to anomalies of the aortic arch and great vessels, diagnosed from 1974 to 2000. Age at the time of operation ranged from 2 weeks to 12 years (mean, 1.7 years). The male to female ratio was 2 to 1. The number of patients presenting per decade was 17 in the 1970s, 21 in the 1980s, and 44 in the 1990s.
Types of vascular anomalies
Patients were categorized according to six types of vascular anomalies: (1) double aortic arch (31 patients); (2) right arch left ligamentum (22 patients); (3) innominate artery compression (20 patients); (4) aberrant right subclavian artery (4 patients); (5) pulmonary artery sling (3 patients); and (6) aberrant left subclavian artery (2 patients). Out of those patients with double aortic arch, right dominance occurred in 25 patients (81%), left dominance in 5 patients (16%), and codominance in
Comment
Gross and Ware [10] defined the operative repair of double aortic arch in 1945 and the surgical management of other vascular anomalies in 1946, indicating the utility of left thoracotomy for division of the ring or symptomatic vessel. In that same year, Neuhauser [11] described the radiographic criteria for diagnosing the various types of anomalies, based on the chest radiograph and the barium swallow. (For a complete description of these criteria, please see Neuhauser’s article.) In summary,
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2020, Journal of Pediatric SurgeryCitation Excerpt :An anterior approach facilitates arch reconstruction or aortic uncrossing procedures, repair of pulmonary artery sling, ductal ligament division, as well as providing access for repair of structural congenital heart defects. [18] This anterior approach through a median sternotomy also is used to anteriorly move and directly support the ascending aorta, innominate artery, pulmonary artery, the trachea, and the bilateral mainstem bronchi. [20,23,24] As the malformed tracheal rings will often maintain their abnormal restrictive shape after vascular elevation, a direct tracheobronchopexy to the sternum or anterior structures of the neck is often required to open the airways.