Airway management in an infant with double aortic arch

Abstract

A 2-month old male was admitted due to repeated cyanotic attacks. He had suffered from stridor and retractive breathing since birth. Double aortic arch was diagnosed and the vascular ring formed by the double aortic arch was compressing the trachea. Multirow detector computed tomography showed that he had a right-dominant double aortic arch with left ductus arteriosus and an aberrant left subclavian artery, and that the narrowest part of the trachea, where the diameter was 2.0 mm, was located 9.0 mm above the carina. Airway management in patients with extreme narrowing of the trachea is challenging for anesthesiologists. He was scheduled for ligation and division of the left aortic arch and ductus arteriosus. In the operating theater, anesthesia was slowly induced with sevoflurane (0-4%) in oxygen. After mask ventilation was confirmed to be adequate, a 4.0 mm internal diameter endotracheal tube (ETT) was inserted and advanced smoothly beyond the tracheal stenosis. The tip of the ETT was placed just above the carina using a fiber optic bronchoscope (fiberscope) that was passed through the ETT. Since mechanical ventilation was adequate, vecuronium was administered. Surgery was conducted in the right lateral position and using a left thoracotomy approach. Anesthesia was maintained with sevoflurane (2-3%). After positioning, right one-lung ventilation was performed unexpectedly. However, anesthetic management was achieved without difficult ventilation during surgery. The tip of the ETT was pulled past the stenotic part before transfer to the intensive care unit (ICU). A patent trachea during spontaneous breathing under CPAP (5 and 2 cmH(2)O) was confirmed with a bronchofiberscope in the ICU. After weaning from mechanical ventilation, he had the persistence of mild stridor despite improvement of respiratory symptoms.

Double Aortic Arch in Adolescence: A Case Report

“…Gastrointestinal symptoms may consist of feeding problems, vomiting, and failure to thrive due to the compression of the esophagus. These symptoms may appear later in life due to an enlargement of the aortic structure caused by atherosclerotic changes [4] [6]. Our patient experienced persistent cough due to trachea compression.…”

“…Patients with DAA may experience respiratory and gastrointestinal symptoms due to the formation of a vascular ring around the trachea and esophagus [4]. If the vascular ring compresses the trachea, respiratory symptoms may include snoring, shortness of breath, cough, recurrent respiratory infections, apnea, and cyanosis, which mainly occur in the newborn period.…”

“…For children aged less than 2 years, symptoms are typically respiratory in nature, while older children and adults frequently present with dysphagia and rarely show respiratory symptoms [4]. Diagnosing DAA is challenging because it has a wide clinical spectrum.…”

Doble arco aórtico. Reporte y análisis de caso en un paciente colombiano

“…Se trata de estructuras anómalas vasculares y/o ligamentosas que rodean la tráquea y el esófago, capaces de producir síntomas por compresión (1). Aunque su prevalencia es difícil de determinar debido a que muchos de ellos pueden ser asintomáticos, se estima que representan alrededor del 1% de todas las anomalías cardiovasculares congénitas (2,3,4) y su pronóstico depende en gran parte de la sospecha clínica oportuna a partir de una historia clínica y un examen físico exhaustivo.…”

Double Aortic Arch – A Case Study

“…However, there are occasions when DAA remain undiagnosed. 4 We report a case of a middle aged man with DAA which is diagnosed after doing a CT angiogram for chronic cough and dyspnea. …”