title: Descending Aortic Translocation for Relief of Distal Tracheal and Proximal Bronchial Compression.
abstract: BACKGROUND
  A descending thoracic aorta that traverses the midline is an uncommon cause of airway compression affecting the distal trachea and proximal main bronchi. Posterior aortopexy has had inconsistent results.
  
  
  METHODS
  A retrospective review determined that, since 2004, 5 children have undergone descending aortic translocation at Texas Children's Hospital. The average age at the time of surgical treatment was 4.2 years, and all patients presented with recurring respiratory illness requiring hospitalization. All patients had preoperative imaging (4 patients with computed tomography scans and 1 with magnetic resonance imaging) confirming a compromised airway caused by a midline aorta, and 4 of the 5 patients had perioperative bronchoscopy. Three patients had a right-dominant double aortic arch. Descending aortic translocation was performed through a midline sternotomy with cardiopulmonary bypass and deep hypothermia. The proximal descending aorta was transected distal to the subclavian artery, brought up through the transverse sinus caudad to the tracheal carina and pulmonary artery, and anastomosed in an end-to-side fashion to the ascending aorta.
  
  
  RESULTS
  Mean cardiopulmonary bypass was 144.8 ± 32.6 minutes, with an aortic cross-clamp time of 59 ± 40.9. Absence of perfusion to the descending thoracic aorta averaged 44.4 ± 13.7 minutes. Concomitant procedures were performed in 4 of the 5 patients. At a median follow-up of 26 months (range, 3 to 101 months), all patients had resolution of symptoms.
  
  
  CONCLUSIONS
  A midline descending aorta can cause compression of the tracheal carina and proximal bronchi, with debilitating symptoms. Translocation of the descending aorta is a reliable procedure that relieves the compression and results in long-term resolution of symptoms.
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas. Electronic address: edmckenz@texaschildrens.org.
authors.forename: E Dean
authors.initials: ED
authors.lastname: McKenzie
authors.affiliation: Division of Congenital Cardiac Surgery, Department of Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Roeser
authors.affiliation: Division of Pediatric Cardiovascular Surgery, Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.
authors.forename: Jess L
authors.initials: JL
authors.lastname: Thompson
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
authors.forename: Luis E
authors.initials: LE
authors.lastname: De León
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
authors.forename: Iki
authors.initials: I
authors.lastname: Adachi
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Heinle
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Mery
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Fraser
mesh_terms: D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001980:Bronchi / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000000981:diagnostic imaging