Concomitant management of airway and its adjacent vascular pathology in addition to repair of congenital cardiac defects

Respiratory symptoms are often present in infants with congenital cardiac a nomalies, but the intrinsic pathology of the airway itself or external comp ression by abnormal vessels is frequently undetected before cardiac repair. We collected 12 patients with airway pathology from July 1996 to October 1 998; all had definite diagnosis of lesions of the airway and its adjacent v essels by preoperative ultrafast computed tomography. Four had intrinsic pa thology (one retrotracheal diverticulum, three tracheal stenosis) as well a s external compression. Among them, six had complete vascular ring, four pa rtial rings and three had bronchial compression by aneurysmal dilatation of branch pulmonary arteries. Simultaneous airway repair (one diverticulectom y, three patch tracheoplasty) and external decompression were performed in ten cases under cardiopulmonary bypass, nine of ten had simultaneous cardia c repair; the other two were done before cardiac repair. All survived excep t three. We concluded that ultrafast computed tomography is indispensable f or definite diagnosis of airway and adjacent cardiovascular pathology. Mere repair of congenital cardiac defects without rectification of the airway a nd its adjacent structures is incompatible with survival. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.