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Backer CL, Mongé MC, Wallen WJ, Eltayeb O. The aortic uncrossing procedure. J Thorac Cardiovasc Surg 2024; 167:413-419. [PMID: 37406764 DOI: 10.1016/j.jtcvs.2023.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Cross-sectional imaging allows identification of rare patients with a vascular ring and circumflex aorta. The key diagnostic feature is crossing of the transverse aortic arch from right to left posterior to the trachea and superior to the carina in a patient with a right aortic arch. We evaluated our patients who received an aortic uncrossing procedure. METHODS We reviewed all patients who underwent aortic uncrossing from 2002 to 2022. All patients received preoperative computed tomography imaging and bronchoscopy. RESULTS Eleven patients ranging in age from 1.5 to 10 years (median 4 years) underwent aortic uncrossing. Two patients had prior left ligamentum division, and 3 patients had prior left aortic arch division. All had significant clinical symptoms. Eight patients had deep hypothermic circulatory arrest (mean 34 minutes), and 3 patients had antegrade cerebral perfusion (median, 28 minutes). Patch material was not used for aortic augmentation, and no patient underwent a posterior tracheopexy or rotational esophagoplasty. Postoperative length of stay ranged from 4 to 31 days (median, 5 days). One patient required a temporary tracheostomy for bilateral recurrent laryngeal nerve paresis, which recovered. One patient required an aortic extension graft to alleviate esophageal compression from an unusual ectatic esophageal course. All patients had relief of airway symptoms and dysphagia. CONCLUSIONS In properly selected patients with a right aortic arch and circumflex aorta, aortic uncrossing is a safe and effective therapy to treat airway and esophageal compression. The procedure can be conducted with deep hypothermic circulatory arrest or antegrade cerebral perfusion. Careful attention to the location of the esophagus and recurrent laryngeal nerves is required.
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Affiliation(s)
- Carl L Backer
- Section of Pediatric Cardiothoracic Surgery, UK HealthCare Kentucky Children's Hospital, Lexington, Ky; Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, Ohio.
| | - Michael C Mongé
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert J. Lurie, Children's Hospital of Chicago, Chicago, Ill; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - William J Wallen
- Section of Pediatric Cardiothoracic Surgery, UK HealthCare Kentucky Children's Hospital, Lexington, Ky; Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, Ohio
| | - Osama Eltayeb
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert J. Lurie, Children's Hospital of Chicago, Chicago, Ill; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Lee C, Lee WY, Shin JA, Lee JY. Descending aortic translocation for left aortic arch with right descending aorta and coarctation of the aorta. Cardiol Young 2023; 33:2664-2666. [PMID: 37791533 DOI: 10.1017/s1047951123003311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Left aortic arch with right descending aorta associated with coarctation of the aorta is a rare congenital cardiac anomaly. Conventional aortic arch repair in this condition may cause airway compression by the abnormally coursing descending aorta. We present the case of a neonate with this anomaly who underwent successful descending aortic translocation to prevent postoperative left main bronchial stenosis.
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Affiliation(s)
- Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won Young Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Ae Shin
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Young Lee
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Zhang Y, Huang J, Xu W, Yao S, Rao J, Liu Q, Sun S. Descending aorta translocation for bronchial stenosis caused by shorter interaortic distance. J Card Surg 2022; 37:3951-3954. [PMID: 35900299 DOI: 10.1111/jocs.16811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/28/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Numerous anatomic relationships of arteries could cause extrinsic compression of the trachea or bronchus. We report a rare left bronchial stenosis just caused by shorter inter-aortic distance. METHODS One patient wih recurrent coughing and wheezing was diagnosed as left emphysema.Cardiac computed tomography (CTA) shows a shorter distance between ascending aorta (AAo) and descending aorta (DAo) caused left bronchial stenosis with extrinsic compression of right pulmonary artery. RESULTS A translocation of the descending aorta was performed in this patient, and postoperative CTA showed that the DAo was translocated to the AAo and the left main bronchial stenosis was relieved. CONCLUSIONS Translocation of the DAo was necessary for the rare left bronchial stenosis caused by shorter inter-aortic distance and could bring a good outcome.
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Affiliation(s)
- Yong Zhang
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Jingsi Huang
- Heart Center, Guangdong Maternal and Child Hospital, Guangdong, People's Republic of China
| | - Weibin Xu
- Heart Center, Guangdong Maternal and Child Hospital, Guangdong, People's Republic of China
| | - Shiwen Yao
- Heart Center, Guangdong Maternal and Child Hospital, Guangdong, People's Republic of China
| | - Jiao Rao
- Heart Center, Guangdong Maternal and Child Hospital, Guangdong, People's Republic of China
| | - Qin Liu
- Heart Center, Guangdong Maternal and Child Hospital, Guangdong, People's Republic of China
| | - Shanquan Sun
- Heart Center, Guangdong Maternal and Child Hospital, Guangdong, People's Republic of China
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Miwa K, Iwai S, Nagashima T. Coarctation of Aorta with Circumflex Aorta: Risk of Bronchial Compression and Recoarctation. Ann Thorac Surg 2022; 114:e461-e463. [DOI: 10.1016/j.athoracsur.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/26/2022] [Accepted: 02/06/2022] [Indexed: 11/01/2022]
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Bronchomalacia in right aortic arch treated with descending aortic translocation and airway splint. Ann Thorac Surg 2021; 113:e187-e189. [PMID: 34081976 DOI: 10.1016/j.athoracsur.2021.04.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022]
Abstract
Management of recurrent symptomatic tracheobronchomalacia and tracheobronchial compression after prior aortopexy and tracheobronchopexy is a surgical challenge. In patients with right aortic arch, the course of the aortic arch over the right mainstem bronchus can result in superior and posterior compression of the airway. We present two cases of recurrent bronchomalacia and bronchial compression treated with descending aortic translocation. The addition of bronchial splinting to aortic translocation effectively relieved airway symptoms.
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Sang CJ, Hebson C. Noisy Breathing in an Infant: A Case Report. Cureus 2021; 13:e13015. [PMID: 33665045 PMCID: PMC7920572 DOI: 10.7759/cureus.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The diagnosis of vascular rings is challenging and may be delayed as symptoms overlap with more common conditions associated with childhood. Underlying genetic associations of this condition remain largely undiscovered. In this report, we present a patient with a double aortic arch and highlight the importance of diagnostic imaging. We also engage in a review of the important genetic considerations.
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Affiliation(s)
- Charlie J Sang
- Internal Medicine/Pediatrics, University of Alabama at Birmingham, Birmingham, USA
| | - Camden Hebson
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, USA
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Beckerman Z, Mery CM. Tracheobronchomalacia: Does One Size Fit All? Semin Thorac Cardiovasc Surg 2019; 31:486-487. [PMID: 31077809 DOI: 10.1053/j.semtcvs.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/06/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Ziv Beckerman
- Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin, Texas; Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas
| | - Carlos M Mery
- Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin, Texas; Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas.
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Mongé MC, Hauck AL, Popescu AR, Forbess JM, Backer CL. Descending Aortic Translocation and Right Pulmonary Artery Reimplantation for Midline Descending Aorta and Crossed Pulmonary Arteries in an Infant. World J Pediatr Congenit Heart Surg 2019; 10:111-115. [PMID: 30799720 DOI: 10.1177/2150135118815027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Left mainstem bronchial compression by a midline descending thoracic aorta is a rare anatomic variant. Translocation of the descending thoracic aorta to the ascending aorta has recently been described to treat this condition. We performed an aortic translocation and right pulmonary artery reimplantation in a 4-month-old infant with severe pulmonary hypertension secondary to right pulmonary artery stenosis and left bronchial compression by a midline descending thoracic aorta. The procedure was successful in ameliorating the patient's left mainstem bronchial compression and pulmonary hypertension. Descending aortic translocation should be considered when the left bronchus is compressed causing respiratory symptoms.
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Affiliation(s)
- Michael C Mongé
- 1 Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,2 Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amanda L Hauck
- 3 Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,4 Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrada R Popescu
- 5 Division of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,6 Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joseph M Forbess
- 1 Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,2 Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carl L Backer
- 1 Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,2 Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Shieh HF, Smithers CJ, Hamilton TE, Zurakowski D, Visner GA, Manfredi MA, Jennings RW, Baird CW. Descending Aortopexy and Posterior Tracheopexy for Severe Tracheomalacia and Left Mainstem Bronchomalacia. Semin Thorac Cardiovasc Surg 2019. [DOI: 10.1053/j.semtcvs.2018.02.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Varghese R, Sheth R, Kothandam S. Descending aortic translocation procedure for relief of bronchial compression in left aortic arch and right descending aorta. Ann Pediatr Cardiol 2018; 11:278-281. [PMID: 30271018 PMCID: PMC6146846 DOI: 10.4103/apc.apc_151_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Compression of the left bronchus by a right-sided descending aorta arising from a left aortic arch constitutes an exceedingly rare form of vascular ring. This manuscript describes the surgical technique that involves translocation of the descending aorta directly to the proximal ascending aorta, thereby relieving the bronchial compression.
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Affiliation(s)
- Roy Varghese
- Department of Pediatric Cardiac Surgery and Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Ronak Sheth
- Department of Pediatric Cardiac Surgery and Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Sivakumar Kothandam
- Department of Pediatric Cardiac Surgery and Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
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Left aortic arch with right descending aorta and severe coarctation: an unusual "vascular clamp" with airway compression. Cardiol Young 2018; 28:1056-1058. [PMID: 29895337 DOI: 10.1017/s1047951118000665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Left aortic arch with right descending aorta is a rare congenital anomaly. We describe the clinical presentation of this unusual anomaly associated with cardiorespiratory compromise from severe aortic obstruction and left main bronchus compression. The anatomical peculiarities, embryological basis, and surgical solutions are presented.
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Affiliation(s)
- Carl L Backer
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, m/c Box 22, Chicago, IL 60618.
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