Abstract
This review of 28 cases of airway obstruction by vascular anomalies in the past 6 years emphasizes the importance of these anomalies as causes of obstruction, stridor, and apnea in infants as well as the important contribution of telescopic bronchoscopy to the recognition of these lesions, especially compression of the trachea by the innominate artery. There were 20 patients with compression by the innominate artery; four were surgically corrected. Seven vascular ring anomalies were all corrected by operation as was an enlarged left atrium and malformed mitral valve in one patient. Vascular anomalies caused 26% of the obstructive airway lesions in a series of infants who had bronchoscopy for obstruction, stridor, or apnea. Failure to diagnose and treat these entities may result in progressive respiratory embarrassment and even death. Barium esophagogram and aortic arch arteriogram, the traditional modalities for diagnosing vascular rings, may fail to identify tracheal compression by enlarged cardiac chambers or the more common "anomalous" innominate artery. Telescopic bronchoscopy will identify tracheal compression by the innominate artery; furthermore, it will identify the area of compression by the vascular ring. Observation of the compressed area during corrective surgery ensures that the operative manipulations are appropriate and successful in relieving the obstruction. This observation can be facilitated by televised monitoring and videotaping.
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- Ardito J. M., Ossoff R. H., Tucker G. F., Jr, DeLeon S. Y. Innominate artery compression of the trachea in infants with reflex apnea. Ann Otol Rhinol Laryngol. 1980 Sep-Oct;89(5 Pt 1):401–405. doi: 10.1177/000348948008900503. [DOI] [PubMed] [Google Scholar]
- FEARON B., SHORTREED R. TRACHEOBRONCHIAL COMPRESSION BY CONGENITAL CARDIOVASCULAR ANOMALIES IN CHILDREN. SYNDROME OF APNEA. Ann Otol Rhinol Laryngol. 1963 Dec;72:949–969. doi: 10.1177/000348946307200409. [DOI] [PubMed] [Google Scholar]
- Filler R. M., Rossello P. J., Lebowitz R. L. Life-threatening anoxic spells caused by tracheal compression after repair of esophageal atresia: correction by surgery. J Pediatr Surg. 1976 Oct;11(5):739–748. doi: 10.1016/0022-3468(76)90098-1. [DOI] [PubMed] [Google Scholar]
- GROSS R. E., NEUHAUSER E. B. D. Compression of the trachea or esophagus by vascular anomalies. Surgical therapy in 40 cases. Pediatrics. 1951 Jan;7(1):69–83. [PubMed] [Google Scholar]
- Marmon L. M., Bye M. R., Haas J. M., Balsara R. K., Dunn J. M. Vascular rings and slings: long-term follow-up of pulmonary function. J Pediatr Surg. 1984 Dec;19(6):683–692. doi: 10.1016/s0022-3468(84)80353-x. [DOI] [PubMed] [Google Scholar]
- Moës C. A., Izukawa T., Trusler G. A. Innominate artery compression of the Trachea. Arch Otolaryngol. 1975 Dec;101(12):733–738. doi: 10.1001/archotol.1975.00780410025006. [DOI] [PubMed] [Google Scholar]
- Mustard W. T., Bayliss C. E., Fearon B., Pelton D., Trusler G. A. Tracheal compression by the innominate artery in children. Ann Thorac Surg. 1969 Oct;8(4):312–319. doi: 10.1016/s0003-4975(10)66245-5. [DOI] [PubMed] [Google Scholar]
- Roesler M., De Leval M., Chrispin A., Stark J. Surgical management of vascular ring. Ann Surg. 1983 Feb;197(2):139–146. doi: 10.1097/00000658-198302000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schwartz M. Z., Filler R. M. Tracheal compression as a cause of apnea following repair of tracheoesophageal fistula: treatment by aortopexy. J Pediatr Surg. 1980 Dec;15(6):842–848. doi: 10.1016/s0022-3468(80)80290-9. [DOI] [PubMed] [Google Scholar]
- Strife J. L., Baumel A. S., Dunbar J. S. Tracheal compression by the innominate artery in infancy and childhood. Radiology. 1981 Apr;139(1):73–75. doi: 10.1148/radiology.139.1.7010416. [DOI] [PubMed] [Google Scholar]
- Welz A., Reichert B., Weinhold C., Uberfuhr P., Mantel K., Döhlemann C., Hecker W. Innominate artery compression of the trachea in infancy and childhood: is surgical therapy justified? Thorac Cardiovasc Surg. 1984 Apr;32(2):85–88. doi: 10.1055/s-2007-1023354. [DOI] [PubMed] [Google Scholar]
- Wenig B. L., Abramson A. L. Innominate artery compression of the trachea. Bull N Y Acad Med. 1984 Jun;60(5):525–531. [PMC free article] [PubMed] [Google Scholar]