Anomalous ascending aorta causing severe compression of the left bronchus in an infant with ventricular septal defect and pulmonary atresia.
Tracheobronchial compression by cardiovascular structures complicates the course after surgery of congenital heart disease. A 2-month-old boy with ventricular septal defect, pulmonary atresia, and velocardiofacial syndrome had severe left main bronchus obstruction due to external compression by an anomalously oriented ascending aorta. The patient's hypoxemic episodes necessitated extracorporeal membrane oxygenation. We inserted a stent in the left bronchus to open the airway, but the stent was crushed by the anomalous aorta. We later surgically rerouted the aorta and finally restored the patency of the left main bronchus. However, the patient died of fungemia, without being weaned from extracorporeal membrane oxygenation. We conclude that surgery is necessary instead of stent implantation to relieve the external compression of the left bronchus from a vessel with systemic arterial pressure.
Li
Meng-Ju
MJ
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
Wang
Ching-Chia
CC
Chen
Shye-Jye
SJ
Chiu
Shuenn-Nan
SN
Wu
En-Ting
ET
Wang
Jou-Kou
JK
Wu
Mei-Hwan
MH
D000015:Abnormalities, Multiple / Q000175:diagnosis* / Q000601:surgery; D001011:Aorta / Q000002:abnormalities* / Q000601:surgery; D001018:Aortic Diseases / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery; D001027:Aortography / Q000379:methods; D001980:Bronchi / Q000473:pathology / Q000601:surgery; D001982:Bronchial Diseases / Q000151:congenital* / Q000175:diagnosis* / Q000601:surgery; D001995:Bronchography / Q000379:methods; D003251:Constriction, Pathologic / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery; D004868:Equipment Failure; D017809:Fatal Outcome; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008297:Male; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D018633:Pulmonary Atresia / Q000175:diagnosis* / Q000601:surgery; D012086:Reoperation; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods; D014656:Vascular Surgical Procedures / Q000379:methods