Descending Aortic Translocation for Relief of Distal Tracheal and Proximal Bronchial Compression

E. Dean McKenzie, Mark E. Roeser, Jess L Thompson, Luis E. De León, Iki Adachi, Jeffrey S. Heinle, Carlos M. Mery, Charles D. Fraser

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background A descending thoracic aorta that traverses the midline is an uncommon cause of airway compression affecting the distal trachea and proximal main bronchi. Posterior aortopexy has had inconsistent results. Methods A retrospective review determined that, since 2004, 5 children have undergone descending aortic translocation at Texas Children's Hospital. The average age at the time of surgical treatment was 4.2 years, and all patients presented with recurring respiratory illness requiring hospitalization. All patients had preoperative imaging (4 patients with computed tomography scans and 1 with magnetic resonance imaging) confirming a compromised airway caused by a midline aorta, and 4 of the 5 patients had perioperative bronchoscopy. Three patients had a right-dominant double aortic arch. Descending aortic translocation was performed through a midline sternotomy with cardiopulmonary bypass and deep hypothermia. The proximal descending aorta was transected distal to the subclavian artery, brought up through the transverse sinus caudad to the tracheal carina and pulmonary artery, and anastomosed in an end-to-side fashion to the ascending aorta. Results Mean cardiopulmonary bypass was 144.8 ± 32.6 minutes, with an aortic cross-clamp time of 59 ± 40.9. Absence of perfusion to the descending thoracic aorta averaged 44.4 ± 13.7 minutes. Concomitant procedures were performed in 4 of the 5 patients. At a median follow-up of 26 months (range, 3 to 101 months), all patients had resolution of symptoms. Conclusions A midline descending aorta can cause compression of the tracheal carina and proximal bronchi, with debilitating symptoms. Translocation of the descending aorta is a reliable procedure that relieves the compression and results in long-term resolution of symptoms.

Original languageEnglish (US)
Pages (from-to)859-862
Number of pages4
JournalAnnals of Thoracic Surgery
Volume102
Issue number3
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

Fingerprint

Thoracic Aorta
Bronchi
Cardiopulmonary Bypass
Aorta
Transverse Sinuses
Subclavian Artery
Sternotomy
Bronchoscopy
Trachea
Hypothermia
Pulmonary Artery
Hospitalization
Perfusion
Tomography
Magnetic Resonance Imaging

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Descending Aortic Translocation for Relief of Distal Tracheal and Proximal Bronchial Compression. / McKenzie, E. Dean; Roeser, Mark E.; Thompson, Jess L; De León, Luis E.; Adachi, Iki; Heinle, Jeffrey S.; Mery, Carlos M.; Fraser, Charles D.

In: Annals of Thoracic Surgery, Vol. 102, No. 3, 01.09.2016, p. 859-862.

Research output: Contribution to journalArticle

McKenzie, ED, Roeser, ME, Thompson, JL, De León, LE, Adachi, I, Heinle, JS, Mery, CM & Fraser, CD 2016, 'Descending Aortic Translocation for Relief of Distal Tracheal and Proximal Bronchial Compression', Annals of Thoracic Surgery, vol. 102, no. 3, pp. 859-862. https://doi.org/10.1016/j.athoracsur.2016.02.044
McKenzie, E. Dean ; Roeser, Mark E. ; Thompson, Jess L ; De León, Luis E. ; Adachi, Iki ; Heinle, Jeffrey S. ; Mery, Carlos M. ; Fraser, Charles D. / Descending Aortic Translocation for Relief of Distal Tracheal and Proximal Bronchial Compression. In: Annals of Thoracic Surgery. 2016 ; Vol. 102, No. 3. pp. 859-862.
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AU - Adachi, Iki

AU - Heinle, Jeffrey S.

AU - Mery, Carlos M.

AU - Fraser, Charles D.

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N2 - Background A descending thoracic aorta that traverses the midline is an uncommon cause of airway compression affecting the distal trachea and proximal main bronchi. Posterior aortopexy has had inconsistent results. Methods A retrospective review determined that, since 2004, 5 children have undergone descending aortic translocation at Texas Children's Hospital. The average age at the time of surgical treatment was 4.2 years, and all patients presented with recurring respiratory illness requiring hospitalization. All patients had preoperative imaging (4 patients with computed tomography scans and 1 with magnetic resonance imaging) confirming a compromised airway caused by a midline aorta, and 4 of the 5 patients had perioperative bronchoscopy. Three patients had a right-dominant double aortic arch. Descending aortic translocation was performed through a midline sternotomy with cardiopulmonary bypass and deep hypothermia. The proximal descending aorta was transected distal to the subclavian artery, brought up through the transverse sinus caudad to the tracheal carina and pulmonary artery, and anastomosed in an end-to-side fashion to the ascending aorta. Results Mean cardiopulmonary bypass was 144.8 ± 32.6 minutes, with an aortic cross-clamp time of 59 ± 40.9. Absence of perfusion to the descending thoracic aorta averaged 44.4 ± 13.7 minutes. Concomitant procedures were performed in 4 of the 5 patients. At a median follow-up of 26 months (range, 3 to 101 months), all patients had resolution of symptoms. Conclusions A midline descending aorta can cause compression of the tracheal carina and proximal bronchi, with debilitating symptoms. Translocation of the descending aorta is a reliable procedure that relieves the compression and results in long-term resolution of symptoms.

AB - Background A descending thoracic aorta that traverses the midline is an uncommon cause of airway compression affecting the distal trachea and proximal main bronchi. Posterior aortopexy has had inconsistent results. Methods A retrospective review determined that, since 2004, 5 children have undergone descending aortic translocation at Texas Children's Hospital. The average age at the time of surgical treatment was 4.2 years, and all patients presented with recurring respiratory illness requiring hospitalization. All patients had preoperative imaging (4 patients with computed tomography scans and 1 with magnetic resonance imaging) confirming a compromised airway caused by a midline aorta, and 4 of the 5 patients had perioperative bronchoscopy. Three patients had a right-dominant double aortic arch. Descending aortic translocation was performed through a midline sternotomy with cardiopulmonary bypass and deep hypothermia. The proximal descending aorta was transected distal to the subclavian artery, brought up through the transverse sinus caudad to the tracheal carina and pulmonary artery, and anastomosed in an end-to-side fashion to the ascending aorta. Results Mean cardiopulmonary bypass was 144.8 ± 32.6 minutes, with an aortic cross-clamp time of 59 ± 40.9. Absence of perfusion to the descending thoracic aorta averaged 44.4 ± 13.7 minutes. Concomitant procedures were performed in 4 of the 5 patients. At a median follow-up of 26 months (range, 3 to 101 months), all patients had resolution of symptoms. Conclusions A midline descending aorta can cause compression of the tracheal carina and proximal bronchi, with debilitating symptoms. Translocation of the descending aorta is a reliable procedure that relieves the compression and results in long-term resolution of symptoms.

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