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. 1993;20(2):126–129.

Esophageal-aortic erosion associated with double aortic arch and tracheomalacia. Experience with 2 infants.

H A Heck Jr 1, H V Moore 1, W A Lutin 1, L Leatherbury 1, E J Truemper 1, C M Steinhart 1, A L Pearson-Shaver 1
PMCID: PMC325076  PMID: 8334365

Abstract

Patients with double aortic arch may require lengthy intubation for ventilatory support. The need for endotracheal and nasogastric intubation may be prolonged in such patients because of associated tracheomalacia. Iatrogenic tracheal or esophageal erosion with subsequent aortic fistulization is an unusual but catastrophic complication that may result from such intubation. We report the cases of 2 infants with double aortic arch and tracheomalacia who developed iatrogenic esophageal-aortic erosion. This complication was successfully managed in 1 of the infants. We conclude from our experience that the important steps in preventing this complication include 1) expediting the exclusion of upper-airway compromise in intubated infants who have a presentation characteristic of bronchospastic airway disease (hyperinflation and hypercapnia) that seems unresponsive to usual therapeutic measures; and 2) expediting the diagnosis of vascular ring in order to minimize the duration of dual tracheal and esophageal intubation. Effective management of this problem, once established, requires primary closure of the esophageal perforation, removal of the nasogastric tube, interposition of thick viable tissue between the esophagus and the aorta, and decompressive gastrostomy and feeding jejunostomy. Concomitant aortopexy may be appropriate.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Applebaum H., Woolley M. M. Pericardial flap aortopexy for tracheomalacia. J Pediatr Surg. 1990 Jan;25(1):30–32. doi: 10.1016/s0022-3468(05)80159-9. [DOI] [PubMed] [Google Scholar]
  2. Arciniegas E., Hakimi M., Hertzler J. H., Farooki Z. Q., Green E. W. Surgical management of congenital vascular rings. J Thorac Cardiovasc Surg. 1979 May;77(5):721–727. [PubMed] [Google Scholar]
  3. Azarow K. S., Pearl R. H., Hoffman M. A., Zurcher R., Edwards F. H., Cohen A. J. Vascular ring: does magnetic resonance imaging replace angiography? Ann Thorac Surg. 1992 May;53(5):882–885. doi: 10.1016/0003-4975(92)91459-m. [DOI] [PubMed] [Google Scholar]
  4. Backer C. L., Ilbawi M. N., Idriss F. S., DeLeon S. Y. Vascular anomalies causing tracheoesophageal compression. Review of experience in children. J Thorac Cardiovasc Surg. 1989 May;97(5):725–731. [PubMed] [Google Scholar]
  5. Bertolini A., Pelizza A., Panizzon G., Moretti R., Bava C. L., Calza G., Tacchino A. Vascular rings and slings. Diagnosis and surgical treatment of 49 patients. J Cardiovasc Surg (Torino) 1987 May-Jun;28(3):301–312. [PubMed] [Google Scholar]
  6. Chun K., Colombani P. M., Dudgeon D. L., Haller J. A., Jr Diagnosis and management of congenital vascular rings: a 22-year experience. Ann Thorac Surg. 1992 Apr;53(4):597–603. doi: 10.1016/0003-4975(92)90317-w. [DOI] [PubMed] [Google Scholar]
  7. Filston H. C., Ferguson T. B., Jr, Oldham H. N. Airway obstruction by vascular anomalies. Importance of telescopic bronchoscopy. Ann Surg. 1987 May;205(5):541–549. doi: 10.1097/00000658-198705000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Greenholz S. K., Karrer F. M., Lilly J. R. Contemporary surgery of tracheomalacia. J Pediatr Surg. 1986 Jun;21(6):511–514. doi: 10.1016/s0022-3468(86)80222-6. [DOI] [PubMed] [Google Scholar]
  9. Hartyánszky I. L., Lozsadi K., Marcsek P., Hüttl T., Sápi E., Kovács A. B. Congenital vascular rings: surgical management of 111 cases. Eur J Cardiothorac Surg. 1989;3(3):250–254. doi: 10.1016/1010-7940(89)90074-2. [DOI] [PubMed] [Google Scholar]
  10. Miller R. D., Hyatt R. E. Evaluation of obstructing lesions of the trachea and larynx by flow-volume loops. Am Rev Respir Dis. 1973 Sep;108(3):475–481. doi: 10.1164/arrd.1973.108.3.475. [DOI] [PubMed] [Google Scholar]
  11. 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]
  12. Vallette R. C., Arensman R. M., Falterman K. W., Ochsner J. L. Tracheoesophageal compression syndromes related to vascular ring. South Med J. 1989 Mar;82(3):338–341. doi: 10.1097/00007611-198903000-00015. [DOI] [PubMed] [Google Scholar]

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