Successful surgical treatment of tracheal compression following right pneumonectomy in infancy. Long-term follow-up.
Two patients (aged 10 and 16 months) underwent right pneumonectomy: one for an oesophageal bronchus, the other for a hypoplastic right lung with sequestration. Both patients subsequently developed severe stridor. The heart rotated to the right and the aortic arch compressed the trachea. This unusual vascular compression was treated by a bypass graft between the ascending and descending aorta and division of the aortic arch between the left carotid and left subclavian artery at the age of 5 years and 4 months, and 20 months respectively. The postoperative recovery was uneventful in the first patient. The second patient required 7 weeks of ventilatory support. Both patients are well (14 and 7 years after surgery). Cardiac catheterisation and angiography in the first patient and Doppler echocardiography in the second demonstrated unrestricted flow through the graft into the descending aorta. Pulmonary function studies showed a restrictive defect with some obstruction in both children. Despite this finding, both patients enjoy a normal life with some sporting activities. The long-term results suggest the effectiveness of this procedure in the treatment of this rare but severe complication of pneumonectomy in infancy.
Thoracic Unit, Hospital for Sick Children, London, UK.
P
P
Horvath
R
R
Dinwiddie
J
J
Stark
D001011:Aorta / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008168:Lung / Q000002:abnormalities / Q000601:surgery; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012129:Respiratory Function Tests; D012135:Respiratory Sounds