UNUSUAL FORMS OF TRACHEOBRONCHIAL COMPRESSION IN INFANTS WITH CONGENITAL HEART-DISEASE

Three groups of unusual forms of tracheobronchial compression caused b y vascular anomalies are presented, Three patients had an encircling r ight aortic arch with a left-sided descending aorta and ligamentum art eriosum (group 1), two patients had airway compression caused by a pin cer effect between a malposed and enlarged ascending aorta and the des cending aorta (group 2), and three patients had airway compression aft er an arterial switch operation for transposition of the great arterie s (group 3). Symptoms developed in all patients before the age of 4 mo nths, and six of them had multiple failed attempts at extubation befor e the surgical intervention directed at relieving the airway compressi on, Fiberoptic endoscopy was used in all patients as a first-line diag nostic tool and was 100% accurate in establishing the diagnosis, The o perations performed were aortic uncrossing in group 1, dissection and aortopexy of the right or left main bronchus in group 2, and dissectio n of the left main bronchus and lysis of adhesions in group 3, In grou p 1 there was one early death, resulting from aspiration, and one late death 4 years later, resulting from an unrelated cause. In this group , bronchomalacia was noted after the operation and resolved gradually in the year after the intervention, In group 2, one patient died of an aortobronchial fistula after placement of a bronchial stent, Group 3 patients had good postoperative results, Two of them are completely sy mptom-free and one has residual bronchomalacia and may need placement of a bronchial stent.