Innominate Artery Compression of the Trachea in Infants with Reflex Apnea

Abstract

Compression of the trachea by an anomalous innominate artery in association with reflex apnea is a frequent cause of respiratory arrest in infants. Once considered, tracheoscopy is mandatory to rule out this disorder. Surgical correction of this condition by innominate arteriopexy has proven to be a very effective method of management. Seventy-eight patients with tracheal compression by an anomalous innominate artery managed by the authors at The Children's Memorial Hospital in Chicago between January 1977 and December 1979 are presented. In this series, 28 patients had a history of one or more episodes of reflex apnea; all of these patients underwent an innominate arteriopexy. A complete review of this syndrome and methods of its diagnosis are scrutinized. We agree with previous authors that reflex apnea is a definite indication for surgical correction of this vascular anomaly causing tracheal compression, but other indications are delineated.

Esophageal Atresia, Tracheomalacia and Arterial Compression: Role of Aortopexy

“…It is simple and gives equally reliable results (1,4,15) without requiring sternotomy. Another advantage is that both the aortic arch and the innominate artery are translocated, which is not the ease for isolated reimplantation of the innominate artery.…”

Anatomical variation in the position of the brachiocephalic trunk (innominate artery) with respect to the trachea: A computed tomography‐based study and literature review of innominate artery compression syndrome

“…In the 1960s several larger case series were published (Fearon and Shortreed, 1963;Mustard et al, 1969). Surgical correction gained popularity (Mustard et al, 1969;MacDonald and Fearon, 1971;Moës, 1975;Ardito, 1980;Backer, 1989). However, ''enjoying an immediate and enthusiastic vogue'', IACS ''was extensively over diagnosed and subsequently fell into disrepute'' (Waldman et al, 1980).…”

“…Angiographic studies continued to confirm that tracheal compression was indeed secondary to the BT. Many authors subsequently challenged the idea that a left sided BT origin is an abnormal finding in children (Maurseth, 1966;Berdon, 1969;Ericsson and Söderlund, 1969;Mustard et al, 1969;Park et al, 1971;Moës, 1975, Ardito, 1980Waldman et al, 1980;Strife et al, 1981;Fletcher and Cohn, 1989;Mandell et al, 1994). Indentation of the trachea on a lateral chest radiograph was a frequent finding even in children without ORS but, with an understandable lack of angiographic data in entirely normal infants, patients with congenital cardiovascular anomalies were used to represent a control population in two large studies (Remy et al, 1974;Strife et al, 1981).…”

“…A description of the anatomical ''anomaly'' persists in popular general radiological and paediatric reference texts (Bernstein, 2007;Dähnert, 2007;Nicholson and Patel, 2007). Reports of IACS, explained in terms of an abnormal left sided BT origin, have continued into the 21st century (Park et al, 1971;Ardito, 1980;Brewster et al, 1985, Filston et al, 1987Backer, 1989;de Baets et al, 1993;Yalçinbas et al, 2006, Lee et al, 2008.…”

“…This description of the anatomical ''anomaly'' has survived into the 21st century and persists in popular general radiological and paediatric reference texts (Bernstein, 2007;Dähnert, 2007;Nicholson and Patel, 2007). This is despite the fact that it has long been brought into question with many challenging the idea that a left sided origin of the BT is abnormal in children (Maurseth, 1966;Berdon, 1969;Ericsson and Söderlund, 1969;Mustard et al, 1969;Park et al, 1971;Moës, 1975, Ardito, 1980Waldman et al, 1980;Strife et al, 1981;Fletcher and Cohn, 1989;Mandell et al, 1994). There are, however, minimal data on the normal anatomy and its variation in children without either obstructive respiratory symptoms (ORS) or congenital heart disease (CHD).…”