Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 21:11:1227819.
doi: 10.3389/fped.2023.1227819. eCollection 2023.

Pediatric airway compression in aortic arch malformations: a multidisciplinary approach

Francesca Petreschi #  1 , Antonella Coretti #  1 , Federica Porcaro #  1 , Alessandra Toscano  2 , Cosimo Marco Campanale  2 , Marilena Trozzi  3 , Aurelio Secinaro  4 , Annalisa Allegorico  1 , Renato Cutrera  1 , Adriano Carotti  5
Affiliations

Pediatric airway compression in aortic arch malformations: a multidisciplinary approach

Francesca Petreschi et al. Front Pediatr. .

Abstract

Background: Aortic arch malformations (AAMs) should be suspected in the presence of persistent respiratory symptoms despite medical treatment or feeding problems at the pediatric age.

Aim: We report a descriptive cohort of patients with AAMs and the local management protocol applied.

Methods: A total of 59 patients with AAM were retrospectively reviewed. Three groups were identified: double aortic arch (DAA), group 1; complete vascular ring (non-DAA), group 2; and anomalous origin of the innominate artery (IA), group 3.

Results: Prenatal diagnosis was available for 62.7% of the patients. In all, 49.2% of children were symptomatic. There was a significantly different prevalence of respiratory symptoms within the three groups: 73.7% in group 1, 24.2% in group 2, and 100% in group 3 (p-value: <0.001). Surgery was considered in the presence of symptoms in patients with DAA and in those with reduction of the tracheal section area greater than 50%. A total of 52.5% of the patients underwent surgical repair (median age 6 months). The median follow-up interval was 21.9 months. Respiratory symptoms improved in most symptomatic patients.

Conclusions: No specific protocols are available for the management of patients with AAMs. Conservative treatment seems to be reasonable for asymptomatic patients or those with airway stenosis less than 50%. A close follow-up is necessary to identify early patients who become symptomatic.

Keywords: airway compression; aortic arch malformations; stridor; surgical treatment; tracheomalacia.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
CT axial view showing double aortic arch with dominant right aortic arch (RAA) and hypoplastic left aortic arch (LLA) compressing the trachea.
Figure 2
Figure 2
CT axial view showing right aortic arch (RAA) with aberrant left subclavian artery and Kommerell's diverticulum compressing the trachea with estimated lumen reduction of 55%; left coronary artery (LCA).
Figure 3
Figure 3
CT axial (A) and coronal (B) views showing left aortic arch with normal branching pattern and innominate artery (IA) anteriorly and laterally compressing the trachea; LCA, left coronary artery; LSA, left subclavian artery.
Figure 4
Figure 4
Timing and need of surgery (expressed in months) in 31 children: Kaplan–Meier analysis.
Figure 5
Figure 5
Diagnostic and therapeutic approach to pediatric airway compression in aortic arch malformations adopted at Bambino Gesù Children's Hospital.
See this image and copyright information in PMC

References

    1. Kocis KC, Midgley FM, Ruckman RN. Aortic arch complex anomalies: 20-year experience with symptoms, diagnosis, associated cardiac defects, and surgical repair. Pediatr Cardiol. (1997) 18(2):127–32. 10.1007/s002469900130 - DOI - PubMed
    1. Woods RK, Sharp RJ, Holcomb GW, 3rd, Snyder CL, Lofland GK, Ashcraft KW, et al. Vascular anomalies and tracheoesophageal compression: a single institution’s 25-year experience. Ann Thorac Surg. (2001) 72(2):434–8; discussion 438–439. 10.1016/s0003-4975(01)02806-5 - DOI - PubMed
    1. Porcaro F, Ciliberti P, Petreschi F, Secinaro A, Allegorico A, Coretti A, Cutrera R. Long term respiratory morbidity in patients with vascular rings: a review. Ital J Pediatr. (2023) 49(1):24. 10.1186/s13052-023-01430-x - DOI - PMC - PubMed
    1. Licari A, Manca E, Rispoli GA, Mannarino S, Pelizzo G, Marseglia GL. Congenital vascular rings: a clinical challenge for the pediatrician. Pediatr Pulmonol. (2015) 50(5):511–24. 10.1002/ppul.23152 - DOI - PubMed
    1. Tola H, Ozturk E, Yildiz O, Erek E, Haydin S, Turkvatan A, et al. Assessment of children with vascular ring. Pediatr Int. (2017) 59(2):134–40. 10.1111/ped.13101 - DOI - PubMed

LinkOut - more resources