The effect of a right-sided aortic arch on outcome in children with esophageal atresia and tracheoesophageal fistula.
During repair of an esophageal atresia with tracheoesophageal fistula (EA/TEF), a right-sided aortic arch (RAA) presents a technical challenge. We reviewed our experience with EA/TEF focusing on the impact of RAA.


METHODS
A retrospective review of patients with EA/TEF at our institution from 1990 to 2004 was performed. Of 61 patients, 53 had a left aortic arch (LAA) and 8 had RAA.


RESULTS
The mean gestational age and birth weight were similar between patients with LAA and RAA. There were more vascular rings in patients with RAA than with LAA (37.5% vs 3.8%, P = .009). A preoperative echocardiogram correctly identified the location of the arch in all with LAA but only 62.5% of those with RAA. Operative complications occurred in 25% of patients with RAA and 11% of patients with LAA.


CONCLUSIONS
Management of a child with RAA and EA/TEF is technically challenging. Preoperative identification of the great vessel anomalies may impact operative decision making. Therefore, careful diagnostic evaluation of a patient with an aortic arch that cannot be easily defined by ECHO should be considered before definitive repair.
Allen
Steven R
SR
Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Ignacio
Romeo
R
Falcone
Richard A
RA
Alonso
Maria H
MH
Brown
Rebeccah L
RL
Garcia
Victor F
VF
Inge
Thomas H
TH
Ryckman
Frederick C
FC
Warner
Brad W
BW
Azizkhan
Richard G
RG
Tiao
Gregory M
GM
D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000601:surgery*; D001724:Birth Weight; D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000601:surgery*; D016896:Treatment Outcome