Aortopexy With Preoperative Computed Tomography and Intraoperative Bronchoscopy for Patients With Central Airway Obstruction After Surgery for Congenital Heart Disease: Postoperative Computed Tomography Results and Clinical Outcomes

Abstract

Bronchoscopy-guided aortopexy is a surgical management option for patients with central airway obstruction after congenital heart surgery. This study aimed to evaluate the usefulness of bronchoscopy-guided aortopexy based on midterm follow-up evaluation with computed tomography (CT) and clinical outcome. From January 2004 to August 2011, bronchoscopy-guided aortopexy was performed for 16 patients (median age 0.5 years, M:F = 10:6) who had central airway obstruction caused by extrinsic compression (13 in the left main bronchus, 2 in the trachea, 1 in the diffuse trachea and bronchus) after congenital heart surgery. The surgical site for aortopexy was determined by the anatomic relationship between the aorta and the compressed bronchus according to preoperative CT and intraoperative bronchoscopy. The median follow-up period was 2.3 years. The ratios of the diameter and area of stenosis at the narrowed point were estimated using pre- and postoperative CT. Almost all the patients (15/16) showed relief of their preoperative symptoms. The median extubation time was 18 h. The stenosis diameter and area ratios significantly improved, as shown by with the immediate postoperative CT (7.7-48.5%, p = 0.003; 54.8-80.5%, p = 0.006). Airway stenosis of more than 75% (p = 0.013), immediate diameter ratio improvement of <50% (p = 0.015), preoperative severe respiratory insufficiency (p = 0.038), and male sex (p = 0.024) were associated with recurrent minor respiratory susceptibility. Bronchoscopy-guided aortopexy is a safe and reliable surgical management choice for central airway obstruction after congenital heart surgery. Furthermore, airway improvement after aortopexy was maintained during the midterm follow-up evaluation, according to CT measurements.

Three‐dimensional printing for surgical planning of a double aortic arch case

“…Surgery consists of resection/division of the nondominant arch, which is the left in 80% of cases, and sometimes atretic. This information is routinely obtained by a CT scan and bronchoscopy 5 . When balanced‐type DAA is encountered, the purpose of surgery is to give a more harmonious configuration to the residual aortic arch, to avoid flow turbulence with the negative hemodynamic effect on ventricular function (Figure 3).…”

“…Over the past years, fiberoptic bronchoscopy was used as the first instrumental investigation to assess the degree of tracheal compression or the presence of tracheomalacia. Computed tomography (CT), subsequently, was considered the gold standard for the anatomic definition for its ability to detect differences between the vascular and respiratory structures 5 …”

Unknown vascular compression of the airway in patients with congenitalheart disease and persistent lower respiratory symptoms

“…When present, the severity of AC was assessed with axial images and airway diameter ratio (ADR) (11). In cases of bronchial compression, the ADR was defined as the ratio of the diameter of the narrowest point of the bronchus to the diameter of the normal bronchus, proximal to the distal bifurcation ( Figure 1).…”

Computed Tomography Imaging in Patients with Congenital Heart Disease Part I: Rationale and Utility. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT)

“…147, M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 13 148, 160-168 In symptomatic patients seeking surgical relief, CT facilitates planning of the surgical approach and helps determine whether tracheal reconstruction or aortopexy will be necessary as well. 169 Cardiovascular CT is well established in the evaluation of pulmonary artery anomalies. Ductal continuation of the pulmonary artery with subsequent ductal closure and pulmonary artery isolation is optimally imaged with CT since the lung parenchyma and associated anomalies can be evaluated.…”