Tracheal compression by aberrant innominate artery: clinical presentations in infants and children, indications for surgical correction by aortopexy, and short- and long-term outcome.
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.
Gardella
Chiara
C
Pulmonary Diseases Department, G. Gaslini Institute, Genoa, Italy.
Girosi
Donata
D
Rossi
Giovanni A
GA
Silvestri
Michela
M
Tomà
Paolo
P
Bava
Gianlauro
G
Sacco
Oliviero
O
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