title: Vascular tracheobronchial compression syndromes-- experience in surgical treatment and literature review.
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.
authors.affiliation: Department of Cardiac Surgery, University Hospital, Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Sebening
authors.forename: H
authors.initials: H
authors.lastname: Jakob
authors.forename: U
authors.initials: U
authors.lastname: Tochtermann
authors.forename: R
authors.initials: R
authors.lastname: Lange
authors.forename: C F
authors.initials: CF
authors.lastname: Vahl
authors.forename: P
authors.initials: P
authors.lastname: Bodegom
authors.forename: G
authors.initials: G
authors.lastname: Szabo
authors.forename: F
authors.initials: F
authors.lastname: Fleischer
authors.forename: K
authors.initials: K
authors.lastname: Schmidt
authors.forename: E
authors.initials: E
authors.lastname: Zilow
authors.forename: W
authors.initials: W
authors.lastname: Springer
authors.forename: H E
authors.initials: HE
authors.lastname: Ulmer
authors.forename: S
authors.initials: S
authors.lastname: Hagl
mesh_terms: D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000002:abnormalities*; D019917:Blood Vessel Prosthesis Implantation; D001982:Bronchial Diseases / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical / Q000379:methods; D004374:Ductus Arteriosus, Patent / Q000150:complications; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000002:abnormalities; D012131:Respiratory Insufficiency / Q000209:etiology; D013577:Syndrome; D014133:Tracheal Diseases / Q000209:etiology / Q000601:surgery*