Mediastinal vascular anomalies causing tracheal and esophageal compression and obstruction in childhood

Over an 11-year period, 22 children have been operated upon at the Hospital for Sick Children, Toronto, for vascular compression of the trachea and esophagus. Thirteen had a double aortic arch; three, a right aortic arch and left ligamentum arteriosum; three, an anomalous innominate artery; and one, an aberrant right subclavian artery. An unusual case of right aortic arch, aberrant left subclavian artery and left ligamentum arteriosum is reported for the first time. One child with an anomalous left pulmonary artery producing emphysema of the right lung is also described. One death occurred during the process of intubation, and three patients died postoperatively despite tracheotomy. These children were in serious condition, and the importance of rigid preoperative and postoperative care, avoiding tracheotomy if possible, is emphasized.

Double aortic arch

The recognition of a double aortic arch which causes significant constriction of the esophagus and trachea is relatively easy if the cardiac symptoms caused by this anomaly are borne in mind. Once suspected, the diagnosis may be confirmed readily by radiographic examination of the esophagus with a barium swallow. The treatment consists of division of the ductus arteriosus (or ligamentum) and of the smaller component, usually the anterior, of the double aortic arch.