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Case Reports
. 2021 Mar 31;16(1):62.
doi: 10.1186/s13019-021-01438-6.

Aortotracheal fistula after slide tracheoplasty in a patient with dextrocardia, left pulmonary artery sling and tracheal stenosis: a case report

Yu-San Chien  1 , Yen-Chun Chao  2 , Kuo-Sheng Lee  3 , Kang-Hong Hsu  4
Affiliations
Case Reports

Aortotracheal fistula after slide tracheoplasty in a patient with dextrocardia, left pulmonary artery sling and tracheal stenosis: a case report

Yu-San Chien et al. J Cardiothorac Surg. .

Abstract

Background: Aortotracheal fistula (ATF) is an uncommon and fatal complication of tracheal or aortic surgery, especially among pediatric patients.

Case presentation: We reported a case in a 1-year-old boy with dextrocardia, left pulmonary artery sling and long segment tracheal stenosis. He received slide tracheoplasty at 9 months of age and had post-operative refractory granulation at distal trachea status post repeated balloon dilatation and laser vaporization. Episodes of hemoptysis occurred on post-operative day 81. Bronchoscopy revealed a pulsating pseudoaneurysm at lower trachea which ruptured during the procedure Urgent surgical repair under cardiopulmonary bypass with deep hypothermic circulatory arrest was done. No recurrent bleeding or significant neurologic deficits noticed at a 4-month follow-up.

Conclusion: Congenital anomaly that changes the spatial relationship between trachea and aorta could have contributed to formation of ATF. This warrant future attention when managing tracheal granulation with this not uncommon anatomy.

Keywords: Aortotracheal fistula; Case report; Dextrocardia; Slide tracheoplasty.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Bronchoscopy showed a pulsating pseudoaneurysm at anterior wall of lower trachea (a) with witnessed rupture during the procedure (b)
Fig. 2
Fig. 2
Contrast-enhanced computed tomography angiography (CTA) showed poor differentiation of the borders between posterior wall of distal aortic arch and anterior wall of lower trachea, but with no contrast extravasation into airway (white arrow indicates aortic arch)
Fig. 3
Fig. 3
Dextrocardia with left aortic arch sitting across his lower trachea
See this image and copyright information in PMC

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