HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Dong-Man Seo Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jhang, W. K. Articles by Gwak, M. Search for Related Content PubMed PubMed Citation Articles by Jhang, W. K. Articles by Gwak, M. Related Collections Trachea and bronchi

---

Original Articles: General Thoracic

Perioperative Evaluation of Airways in Patients With Arch Obstruction and Intracardiac Defects

^a Division of Pediatric Cardiac Surgery, College of Medicine, University of Ulsan, Seoul, Korea
^b Department of Radiology, College of Medicine, University of Ulsan, Seoul, Korea
^c Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea

Accepted for publication January 18, 2008.

^_* Address correspondence to Dr Seo, Division of Pediatric Cardiac Surgery, Asan Medical Center, 388-1 Poongnap-Dong, Songpa-Ku, Seoul, 138-736, Republic of Korea (Email: dmseo{at}amc.seoul.kr).

Background: Patients with arch obstruction and intracardiac defects have a high probability of abnormal aortopulmonary space geometry, which provides airway compression. The tissue-to-tissue technique arch repair could result in real airway problems. This report describes our experience with the perioperative evaluation and management of airway problems.

Methods: We retrospectively reviewed the medical records of 90 patients with arch obstruction and intracardiac defects who underwent computed tomography (CT) and corrective surgery in our institution between January 2000 and January 2007.

Results: Of the 77 patients who underwent preoperative CT (group 1), 21 were found to have airway compression (27.2%).Of those 21 patients, 5 underwent concomitant airway relieving procedures. In group 1, 2 patients required subsequent secondary surgery for airway problems after the initial arch repair. Of the 13 patients who underwent postoperative CT only (group 2), 6 underwent subsequent secondary surgery for airway relief. For airway relief, several procedures were additionally performed (eg, right pulmonary artery translocation anterior to the aorta, aortopexy, peribronchial dissection, and tissue augmentation). In terms of the type of arch repair, 48 patients underwent end-to-side anastomosis, 39 underwent extended end-to-end anastomosis, and 3 underwent end-to-end anastomosis. End-to-side was the repair type most commonly associated with airway compression requiring additional procedure (10 of 15, 66.6%).

Conclusions: Patients with arch obstruction and intracardiac defects had a rather high incidence of airway compression preoperatively and postoperatively. Preoperative CT and intraoperative complementary bronchoscopy were useful for identifying and fixing the airway problems. Additional procedures for relieving airway compression were required more frequently after end-to-side type arch repair than after extended end-to-end anastomosis. More meticulous intraoperative evaluation and management are recommended in this type of repair.