Aortotracheal Fistula after Slide Tracheoplasty in a Patient with Dextrocardia, Left Pulmonary Artery Sling and Tracheal Stenosis: A Case Report

Abstract

Background: Aortotracheal fistula (ATF) is an uncommon and fatal complication of tracheal or aortic surgery, especially among pediatric patients. Case presentation: We reported a case in a 1-year-old boy with dextrocardia, left pulmonary artery sling and long segment tracheal stenosis. He received slide tracheoplasty at 9 months of age and had post-operative refractory granulation at distal trachea status post repeated balloon dilatation and laser vaporization. Episodes of hemoptysis occurred on post-operative day 81. Bronchoscopy revealed a pulsating pseudoaneurysm at lower trachea which ruptured during the procedure. Urgent surgical repair under cardiopulmonary bypass with deep hypothermic circulatory arrest was done. No recurrent bleeding or significant neurologic deficits noticed at a 4-month follow-up. Conclusion: Congenital anomaly that changes the spatial relationship between trachea and aorta could have contributed to formation of ATF. This warrant future attention when managing tracheal granulation with this not uncommon anatomy.

Aortic arch replacement and autologous pericardial tracheal patch for an aorto‐tracheal fistula

“…Two cases of aorto‐tracheal fistula following repair of pulmonary artery sling and tracheoplasty in children are reported, both successfully repaired via cardiopulmonary bypass and repair with pericardial patch of the aortic arch. One tracheal defect was also repaired with pericardial patch and the other with tracheal reconstruction with cadaveric tracheal homograft 4,5 . Given the contamination present in a case like ours, the use of a cryopreserved aortic arch allograft could be considered, but such a homograft may not always be readily available in an emergent setting.…”

“…One tracheal defect was also repaired with pericardial patch and the other with tracheal reconstruction with cadaveric tracheal homograft. 4,5 Given the contamination present in a case like ours, the use of a cryopreserved aortic arch allograft could be considered, but such a homograft may not always be readily available in an emergent setting. Moreover, had our patient not had suitable omentum, other flap options would have included pectoralis major, rectus abdominis, latissimus dorsi, and serratus anterior muscle flaps.…”