title: Perioperative evaluation of airways in patients with arch obstruction and intracardiac defects.
abstract: BACKGROUND
  Patients with arch obstruction and intracardiac defects have a high probability of abnormal aortopulmonary space geometry, which provides airway compression. The tissue-to-tissue technique arch repair could result in real airway problems. This report describes our experience with the perioperative evaluation and management of airway problems.
  
  
  METHODS
  We retrospectively reviewed the medical records of 90 patients with arch obstruction and intracardiac defects who underwent computed tomography (CT) and corrective surgery in our institution between January 2000 and January 2007.
  
  
  RESULTS
  Of the 77 patients who underwent preoperative CT (group 1), 21 were found to have airway compression (27.2%). Of those 21 patients, 5 underwent concomitant airway relieving procedures. In group 1, 2 patients required subsequent secondary surgery for airway problems after the initial arch repair. Of the 13 patients who underwent postoperative CT only (group 2), 6 underwent subsequent secondary surgery for airway relief. For airway relief, several procedures were additionally performed (eg, right pulmonary artery translocation anterior to the aorta, aortopexy, peribronchial dissection, and tissue augmentation). In terms of the type of arch repair, 48 patients underwent end-to-side anastomosis, 39 underwent extended end-to-end anastomosis, and 3 underwent end-to-end anastomosis. End-to-side was the repair type most commonly associated with airway compression requiring additional procedure (10 of 15, 66.6%).
  
  
  CONCLUSIONS
  Patients with arch obstruction and intracardiac defects had a rather high incidence of airway compression preoperatively and postoperatively. Preoperative CT and intraoperative complementary bronchoscopy were useful for identifying and fixing the airway problems. Additional procedures for relieving airway compression were required more frequently after end-to-side type arch repair than after extended end-to-end anastomosis. More meticulous intraoperative evaluation and management are recommended in this type of repair.
authors.affiliation: Division of Pediatric Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Won Kyoung
authors.initials: WK
authors.lastname: Jhang
authors.forename: Jeong-Jun
authors.initials: JJ
authors.lastname: Park
authors.forename: Dong-Man
authors.initials: DM
authors.lastname: Seo
authors.forename: Hyun Woo
authors.initials: HW
authors.lastname: Goo
authors.forename: Mijeung
authors.initials: M
authors.lastname: Gwak
mesh_terms: D000402:Airway Obstruction / Q000000981:diagnostic imaging* / Q000601:surgery*; D000714:Anastomosis, Surgical; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery; D001017:Aortic Coarctation / Q000000981:diagnostic imaging* / Q000601:surgery*; D001980:Bronchi / Q000601:surgery; D001999:Bronchoscopy; D003131:Combined Modality Therapy; D019299:Decompression, Surgical / Q000379:methods; D004210:Dissection; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019990:Perioperative Care; D011651:Pulmonary Artery / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed