Fatal aortotracheal fistula combined with aortoesophageal fistula in an infant with double aortic arch: a warning.
This report describes a 2-month-old male infant with a double aortic arch (DAA) complicated by aortoesophageal fistula (AEF) and aortotracheal fistula (ATF). He was intubated with an endotracheal tube at birth because of neonatal asphyxia. A nasogastric tube was also placed for gastric decompression and milk feeding. On the 74th day of birth, he had massive upper gastrointestinal hemorrhage associated with shock, and was referred to our hospital. Although emergent surgery controlled the bleeding from AEF, he suffered cardiac arrest due to massive bleeding from ATF 5 h after surgery, and died on the 9th postoperative day. Physicians should be aware that prolonged endotracheal and nasogastric intubation predispose to the development of not only esophageal erosion but also more lethal tracheal erosion. In addition to the importance of early diagnosis and prompt surgery for DAA, appropriate preoperative respiratory management is emphasized to prevent similar occurrences in the future.
Department of Cardiovascular Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan. naotaka_atsumi@tmhp.jp.
Naotaka
N
Atsumi
Department of Cardiovascular Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan.
Muneaki
M
Matsubara
Department of Cardiovascular Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan.
Naritaka
N
Kimura
Department of Cardiovascular Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan.
Masatsugu
M
Terada
D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000601:surgery; D004937:Esophageal Fistula / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017809:Fatal Outcome; D006801:Humans; D007223:Infant; D008297:Male; D016156:Respiratory Tract Fistula / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014133:Tracheal Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016157:Vascular Fistula / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods
Aortoesophageal fistula; Aortotracheal fistula; Double aortic arch; Infant