Tracheobronchial compression of vascular origin - Review of experience in infants and children

Background. Tracheobronchial compression of vascular origin is an uncommon but important cause of respiratory distress in infants and children. We rev iewed our surgical experience with 31 children, presenting vascular tracheo bronchial compression. Methods. Thirty-one children, with a median age of seven months, were opera ted on for airway and/or oesophageal compression secondary to vascular anom alies. Diagnostic findings, mainly established by bronchoscopy and angiogra phy, revealed several pathologic disorders such as right aortic arch with a ortic diverticulum in 10, double aortic arch in five, innominate artery com pression in six, arteria lusoria in four, and pulmonary artery sling in one patient. Five children developed tracheobronchial compression after previo us repair of a complex congenital heart disease. Clinical symptoms on admis sion were dominantly stridor, recurrent airway infection, dyspnea, respirat ory distress and upper digestive complaints such as dysphagia and gastroeso phageal reflux. Results. Surgical relief was successful in 30 patients. Only one child with palliated tetralogy of Fallot and pulmonary artery sling died because of i ntractable extensive tracheobronchial stenosis. Late follow-up over three t o 90 months showed a symptom-free evolution in most patients, including one reoperation for recurrent compression and one late death. Conclusions. Tracheobronchial compression by vascular structures in childho od is uncommon and may be masked by nonspecific respiratory symptoms, resul ting in an often delayed diagnosis. Once imaging studies have clearly delin eated the causal pathologic vascular structures, surgical correction is oft en straightforward and effective, in spite of the common presence of trache obronchial malacia.