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Thorac Cardiovasc Surg 2000; 48(3): 164-174
DOI: 10.1055/s-2000-9633
Cardiovascular Review
© Georg Thieme Verlag Stuttgart · New York

Vascular Tracheobronchial Compression Syndromes

Experience in Surgical Treatment and Literature Review[1] Ch. Sebening1 , H. Jakob1 , U. Tochtermann1 , R. Lange1 , C. F. Vahl1 , P. Bodegom5 , G. Szabo1 , F. Fleischer3 , K. Schmidt2 , E. Zilow4 , W. Springer2 , H. E. Ulmer2 , S. Hagl1
  • Departments of 1Cardiac Surgery, 2Pediatric Cardiology, 3Anesthesiology, 4Pediatrics, University Hospital, Heidelberg, Germany
  • 5Center for Thoracic Medicine, Heidelberg, Germany
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Publication History

Publication Date:
31 December 2000 (online)

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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

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

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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

Ch. Sebening

Department of Cardiac Surgery, University Hospital

Im Neuenheimer Feld 110

69120 Heidelberg

Germany

Phone: Tel. 06221 - 566276

Fax: Fax 06221 - 565585