Unusual forms of tracheobronchial compression in infants with congenital heart disease

Abstract

Three groups of unusual forms of tracheobronchial compression caused by vascular anomalies are presented. Three patients had an encircling right aortic arch with a left-sided descending aorta and ligamentum arteriosum (group 1), two patients had airway compression caused by a pincer effect between a malposed and enlarged ascending aorta and the descending aorta (group 2), and three patients had airway compression after an arterial switch operation for transposition of the great arteries (group 3). Symptoms developed in all patients before the age of 4 months, and six of them had multiple failed attempts at extubation before the surgical intervention directed at relieving the airway compression. Fiberoptic endoscopy was used in all patients as a first-line diagnostic tool and was 100% accurate in establishing the diagnosis. The operations performed were aortic uncrossing in group 1, dissection and aortopexy of the right or left main bronchus in group 2, and dissection of the left main bronchus and lysis of adhesions in group 3. In group 1 there was one early death, resulting from aspiration, and one late death 4 years later, resulting from an unrelated cause. In this group, bronchomalacia was noted after the operation and resolved gradually in the year after the intervention. In group 2, one patient died of an aortobronchial fistula after placement of a bronchial stent. Group 3 patients had good postoperative results. Two of them are completely symptom-free and one has residual bronchomalacia and may need placement of a bronchial stent.

Recurrent bronchopulmonary infections in the left lung of a 21-month-old female

“…Recurrent or persistent respiratory symptoms, often associated with focal signs and findings, may be caused by unusual forms of vascular rings, only partially predictable on the basis of clinical presentations, physical examination and plain chest radiographs [12]. A child who has recurrent or persistent focal symptoms and/or abnormalities on chest radiographs may need early consideration of computed tomography of the intrathoracic structures, fibreoptic bronchoscopy, magnetic resonance or angiography [3,12].…”

“…A child who has recurrent or persistent focal symptoms and/or abnormalities on chest radiographs may need early consideration of computed tomography of the intrathoracic structures, fibreoptic bronchoscopy, magnetic resonance or angiography [3,12]. When the diagnosis is made, the results of the multiple diagnostic investigations performed may allow accurate pre-operative planning and evaluation of the structural results obtained by treatment [13].…”

Restoration of Transposed Great Arteries With or Without Subpulmonary Obstruction to Nature

“…Bronchial compression or even atelectasis has been reported after Lecompte maneuver (Robotin et al, 1996;Toker et al, 2000), although in the majority of cases the bcronchial patency was not so severely compromised. Fig.…”

Restoring the spiral flow of nature in transposed great arteries

“…After the Lecompte manoeuvre, however, not only is the anterior MPA (low-pressure) flattened [13], resulting in branch PA stenosis with increased peak velocity during systole [14], but the posterior left bronchus may also be compressed (airway-pressure with cartilage) [15,16]. This occurs when the high-pressure ascending aorta is not restored to its natural location.…”