Between January 1988 and December 1997 a total of 22 patients (age: 8 days - 46 years)
were operated for vascular airway compression syndromes with respiratory insufficiency.
Vascular anomalies in tracheal compression were double aortic arch in 7 patients,
(2 previously operated elsewhere), right aortic arch + left ligamentum arteriosum
in 1, and pulmonary artery sling in 3. Three of these patients had secondary long-segment
tracheomalacia. Compression of trachea and a main bronchus existed in 2 patients with
right aortic arch + left ligamentum. Isolated main bronchus obstruction was present
in 9 patients (abnormal insertion of ligamentum arteriosum in 1, status post (s. p.)
previous operation for PDA in 4, s. p. surgery for coarctation in 1, right aortic
arch + left ligamentum arteriosum in 2, and right lung aplasia + left ligamentum in
1). 3 of these cases had secondary long-segment bronchomalacia. All patients had a
complex respiratory anamnesis [long-term intubation in 7, s. p. tracheostomy in 2
(over 3 months - 3 years), and progressive respiratory insufficiency in 13). In tracheal
compression, surgical correction included transsection of the underlying ring or sling
components (with additional anterior aortic arch translocation in 5 patients resection-reimplantation
of left pulmonary artery in 3, segmental tracheal resection in 1, and external tracheal
suspension in 2). In the 2 cases with compression of the trachea and a main bronchus,
aortic “extension” by a prosthetic tube was necessary. In isolated main bronchus obstruction,
surgical decompression basically consisted of transsection of the ligamentum arteriosum
or resection of its scarry remnant forming the “corner point” of a compression between
aorta and pulmonary artery. In 3 patients with secondary long-segment malacia, additional
external bronchus suspension was performed. Effective decompression and re-expansion
of the airway segment concerned was achieved, and was demonstrated by intraoperative
endoscopy in all patients. There were 3 postoperative deaths (sepsis 2; massive, irreversible
edema of the tracheal mucosa 1). Of the 19 surviving patients 16 could be extubated
between the 1st and 17th (mean = 7.5) postoperative day. In 1 case the preoperative
long-term tracheostomy had to be left in place for inoperable additional laryngeal
stricture. 2 patients had to be reoperated (segmental cervical tracheal resection
after 5 months for primary long-term intubation-related subglottic stenosis in 1,
esophageal decompression for residual dysphagia after 57 months related to a traction
phenomenon at the right descending aorta in the other), both with gratifying results.
In all other patients clinical, endoscopic, and radiographic examinations (follow-up
= 2 months - 6 years) demonstrate good results.
Key words:
Vascular ring and sling - Airway compression - Tracheobronchomalacia
References
Aorta und ductus Botalli persistens, einschl. Schlingenbildung der A. pulmonalis. In: Borst HG, Klinner W, Oelert H (Hrsg.) Kirschnersche allgemeine und spezielle
Operationslehre Bd. 6/2, Herzchirurgie. Springer Verlag 1991: 315-36
1 Dedicated to Professor Francis Fontan Presented in part at the Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, Dresden, February 1998
