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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2001 October;42(5):663-6

language: English

Tracheobronchial compression of vascular origin. Review of experience in infants and children

Bové T., Demanet H., Casimir G. *, Viart P. **, Goldstein J. P., Deuvaert F. E.

From the Department of Cardiac Surgery, Pneumology* and Cardiology**, Hopital Universitaire Des Enfants Reine Fabiola, ULB - VUB Brussels, Belgium


Background. Tracheobronchial com­pres­sion of vas­cu­lar ori­gin is an uncom­mon but impor­tant ­cause of res­pir­a­to­ry dis­tress in ­infants and chil­dren. We ­reviewed our sur­gi­cal expe­ri­ence ­with 31 chil­dren, pre­sent­ing vas­cu­lar tra­che­o­bron­chi­al com­pres­sion.
Methods. Thirty-one chil­dren, ­with a ­median age of seven ­months, ­were oper­at­ed on for air­way and/or oesoph­a­geal com­pres­sion sec­on­dary to vas­cu­lar anom­a­lies. Diagnostic find­ings, main­ly estab­lished by bron­chos­co­py and angio­gra­phy, ­revealed sev­er­al path­o­log­ic dis­or­ders ­such as ­right aor­tic ­arch ­with aor­tic diver­tic­u­lum in 10, dou­ble aor­tic ­arch in five, innom­i­nate ­artery com­pres­sion in six, arte­ria lusor­ia in four, and pul­mo­nary ­artery ­sling in one ­patient. Five chil­dren devel­oped tra­che­o­bron­chi­al com­pres­sion ­after pre­vi­ous ­repair of a com­plex con­gen­i­tal ­heart dis­ease. Clinical symp­toms on admis­sion ­were dom­i­nant­ly stri­dor, recur­rent air­way infec­tion, dysp­nea, res­pir­a­to­ry dis­tress and ­upper diges­tive com­plaints ­such as dys­pha­gia and gas­troe­soph­a­geal ­reflux.
Results. Surgical ­relief was suc­cess­ful in 30 ­patients. Only one ­child ­with pal­li­at­ed tet­ral­o­gy of Fallot and pul­mo­nary ­artery ­sling ­died ­because of intract­able exten­sive tra­che­o­bron­chi­al sten­o­sis. Late fol­low-up ­over three to 90 ­months ­showed a symp­tom-­free evo­lu­tion in ­most ­patients, includ­ing one reop­er­a­tion for recur­rent com­pres­sion and one ­late ­death.
Conclusions. Tracheobronchial com­pres­sion by vas­cu­lar struc­tures in child­hood is uncom­mon and may be ­masked by non­spe­cif­ic res­pir­a­to­ry symp­toms, result­ing in an ­often ­delayed diag­no­sis. Once imag­ing stud­ies ­have clear­ly delin­eat­ed the cau­sal path­o­log­ic vas­cu­lar struc­tures, sur­gi­cal cor­rec­tion is ­often straight­for­ward and effec­tive, in ­spite of the com­mon pres­ence of tra­che­o­bron­chi­al mal­a­cia.

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