ESOPHAGEAL-AORTIC EROSION ASSOCIATED WITH DOUBLE AORTIC-ARCH AND TRACHEOMALACIA - EXPERIENCE WITH 2 INFANTS

Patients with double aortic arch may require lengthy intubation for ve ntilatory support. The need for endotracheal and nasogastric intubatio n may be prolonged in such patients because of associated tracheomalac ia. Iatrogenic tracheal or esophageal erosion with subsequent aortic f istulization is an unusual but catastrophic complication that may resu lt from such intubation. We report the cases of 2 infants with double aortic arch and tracheomalacia who developed iatrogenic esophageal-aor tic erosion. This complication was successfully managed in 1 of the in fants. We conclude from our experience that the important steps in pre venting this complication include 1) expediting the exclusion of upper -airway compromise in intubated infants who have a presentation charac teristic of bronchospastic airway disease (hyperinflation and hypercap nia) that seems unresponsive to usual therapeutic measures; and 2) exp editing the diagnosis of vascular ring in order to minimize the durati on of dual tracheal and esophageal intubation. Effective management of this problem, once established, requires primary closure of the esoph ageal perforation, removal of the nasogastric tube, interposition of t hick viable tissue between the esophogus and the aorta, and decompress ive gastrostomy and feeding jejunostomy. Concomitant aortopexy may be appropriate.