Vascular Tracheobronchial Compression Syndromes - Experience in Surgical Treatment and Literature Review1 -

Abstract

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.

Right Sided Aortic Arch Resembling Asthma

“…Otherwise, symptoms such as cough, dysphagia, exertional dyspnoea, and chest pain usually appear in adulthood [4,5]. In the presented case, dyspnoea with cough might be due to tracheal compression by large vessels during forced expiration [4,5].…”

“…In the presented case, dyspnoea with cough might be due to tracheal compression by large vessels during forced expiration [4,5]. Similar symptoms may manifest in most asthmatic patients in relation to airway hyperreactvity [4,5].…”

“…If the compression of the trachea and oesophagus is severe, the symptoms are likely to occur in infancy and early childhood [4,5]. Otherwise, symptoms such as cough, dysphagia, exertional dyspnoea, and chest pain usually appear in adulthood [4,5].…”

Left Main Bronchus Compression Due to Main Pulmonary Artery Dilatation in Pulmonary Hypertension: Two Case Reports

“…Treatment of tracheobronchial compression in infants and children has been successful with surgical decompression 6,13,16 or endobronchial stenting. 9 In adults, patients are likely to be unsuitable for surgical intervention.…”

Persistan Wheezingin Nadir Bir Nedeni: Pulmoner Arter Sling

“…PAS genellikle yenidoğan ve infant döneminde bulgu verir. Diğer konjenital kalp hastalıklarına eşlik edebilir (6). Tekrarlayan hışıltı ve tekrarlayan alt solunum yolu infeksiyonu nedeniyle kliniğimize başvu-ran sekiz aylık erkek hastada tespit edilen PAS, vasküler ringlerin nadir görülen bir tipi olması nedeniyle sunuldu.…”