| A Case Report of Double Aortic
Arch, Vascular Ring Associated with Tracheal Stenosis |
(Department of Surgery I, Hirosaki University School
of Medicine, Hirosaki, Japan)
| Kazuyuki Daitoku |
Koh Takeuchi |
Hiroyuki Itaya |
| Kazuo Itoh |
Ikkoh Ichinoseki |
Masayuki Koyama |
| Kozo Fukui |
Shunichi Takaya |
|
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We report a case of vascular ring
with tracheal stenosis, which might be related to a prolonged
endotracheal intubation. A symptomatic 2-month-old boy was admitted
to our institution after prolonged intubation without a definite
diagnosis. His symptoms were stridor and dyspnea, but not dysphagia.
Echocardiography detected a vascular ring and this was confirmed
by computed tomography and magnetic resonance imaging (MRI) (Edwards
IA type). The left anterior aortic arch was divided distal to
the left subclavian artery through left thoracotomy and the ligamentum
arteriosus was not identified. On postoperative day (POD) 2,
endotracheal extubation was unsuccessfully attempted. Further
examination such as MRI and bronchoscopy revealed intimal hyperplasia
of the trachea with mild compression of the trachea from the
outside. We performed aortopexy and division of the small long
ductus which might not be a mechanism of the tracheal compression
through right thoracotomy in the second operation with successful
extubation on POD 3. The patient has been discharged from the
hospital and followed up at the outpatient clinic without any
symptom. Tracheomalacia was a common associated anomaly in vascular
ring. However, other mechanisms such as inflammatory reaction
associated with prolonged intubation should be considered and
be avoided in the pediatric population.
Jpn. J. Cardiovasc. Surg. 31：388-391(2002) |
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