Cardiovascular causes of airway compression

Abstract

Compression of the paediatric airway is a relatively common and often unrecognized complication of congenital cardiac and aortic arch anomalies. Airway obstruction may be the result of an anomalous relationship between the tracheobronchial tree and vascular structures (producing a vascular ring) or the result of extrinsic compression caused by dilated pulmonary arteries, left atrial enlargement, massive cardiomegaly, or intraluminal bronchial obstruction. A high index of suspicion of mechanical airway compression should be maintained in infants and children with recurrent respiratory difficulties, stridor, wheezing, dysphagia, or apnoea unexplained by other causes. Prompt diagnosis is required to avoid death and minimize airway damage. In addition to plain chest radiography and echocardiography, diagnostic investigations may consist of barium oesophagography, magnetic resonance imaging (MRI), computed tomography, cardiac catheterization and bronchoscopy. The most important recent advance is MRI, which can produce high quality three-dimensional reconstruction of all anatomic elements allowing for precise anatomic delineation and improved surgical planning. Anaesthetic technique will depend on the type of vascular ring and the presence of any congenital heart disease or intrinsic lesions of the tracheobronchial tree. Vascular rings may be repaired through a conventional posterolateral thoracotomy, or utilizing video-assisted thoracoscopic surgery (VATS) or robotic endoscopic surgery. Persistent airway obstruction following surgical repair may be due to residual compression, secondary airway wall instability (malacia), or intrinsic lesions of the airway. Simultaneous repair of cardiac defects and vascular tracheobronchial compression carries a higher risk of morbidity and mortality.

Flexible bronchoscopy in pulmonary diseases in children with congenital cardiovascular abnormalities

“…Herein, the most common bronchoscopy diagnoses of airway abnormalities consisted of external compression of airways, tracheobronchomalacia, and airway narrowing, which are associated with cardiovascular abnormalities such as ASD, VSD, and PDA. The possible reasons why cardiovascular abnormalities are associated with airway disorders have been discussed elsewhere (1,2,13,14). Notably, a number of rare airway abnormalities such as bridging bronchus, tracheal bronchus, and complete tracheal ring were also presented, for which surgical correction was suggested.…”

Patent Ductus Arteriosus

“…36 One example is the patient with ductus arteriosus aneurysm, which may present as a chest mass. 37,38 Other examples include PDA associated with vascular ring, with right aortic arch, and with cervical arch.…”

Right Aortic Arch With Aberrant Left Innominate Artery

“…As illustrated by the patients described in this report, cardiac magnetic resonance or computed tomographic angiography is usually required for complete anatomic assessment of the vascular ring and the airways. 5 Exceptions to this are infants with a double aortic arch in whom echocardiography fully demonstrates the vascular structures. 6 As with other vascular rings, the decision for surgical intervention is generally determined by symptoms of proximal airway obstruction or esophageal compression.…”