title: Tracheal compression by aberrant innominate artery: clinical presentations in infants and children, indications for surgical correction by aortopexy, and short- and long-term outcome.
abstract: BACKGROUND
  Aberrant innominate artery (AIA) may cause various degrees of tracheal compression (TC).
  
  
  OBJECTIVE
  The aim of this study is to define the clinical manifestations of AIA-induced TC and outcome after aortopexy in infants and older children.
  
  
  METHODS
  Children with significant AIA-induced TC were evaluated, and information after surgery or conservative management was obtained by telephonic interview after 1 to 4 years since discharge.
  
  
  RESULTS
  Overall, 15 infants (mean age, 8 months; group A) and 13 older children (mean age, 56 months; group B) were evaluated. Although median age at onset of symptoms was comparable in the 2 groups, mean delay to diagnosis was higher in group B (P < .0001). Analysis of the most prevalent symptoms showed that reflex apneas were more frequent in group A (P = .02), whereas chronic "intractable" cough was more frequent in group B (P < .001). Because of the type and severity of symptoms and the degree of TC, 16 patients underwent aortopexy. Follow-up evaluation showed, in all but 1 patient, a significant improvement in symptoms and quality of life, measured by a modified Visick score.
  
  
  CONCLUSIONS
  Aberrant innominate artery-TC leads to a variety of respiratory disorders, with a difference in prevalence between infants and older children. When choice of treatment is based on clinical presentation and degree of TC, a good clinical outcome may be obtained also in children in whom aortopexy is indicated, that is, those presenting initially with more severe symptoms.
authors.affiliation: Pulmonary Diseases Department, G. Gaslini Institute, Genoa, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Gardella
authors.forename: Donata
authors.initials: D
authors.lastname: Girosi
authors.forename: Giovanni A
authors.initials: GA
authors.lastname: Rossi
authors.forename: Michela
authors.initials: M
authors.lastname: Silvestri
authors.forename: Paolo
authors.initials: P
authors.lastname: Tomà
authors.forename: Gianlauro
authors.initials: G
authors.lastname: Bava
authors.forename: Oliviero
authors.initials: O
authors.lastname: Sacco
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016122:Brachiocephalic Trunk / Q000002:abnormalities / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013908:Thoracotomy / Q000379:methods; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014135:Tracheal Stenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods