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Ann Thorac Surg 2000;69:929-930
© 2000 The Society of Thoracic Surgeons

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Commentary

^a Service de Chirurgie Cardiovasculaire, Centre Hospitalier Universitaire Vaudois, rue du Bugnon 46, 1011 Lausanne, Switzerland

e-mail: antonio.corno{at}chuv.hospvd.ch

Invited commentary

The authors present two cases of tracheobronchial compression after arterial switch operation for transposition of the great arteries. The topic is very interesting for pediatric cardiologists, anesthetists, cardiac surgeons, and intensivists involved with the perioperative care of infants with congenital heart defects.

In airway obstruction in infants, it is important to distinguish between congenital isolated tracheal stenosis with circular rings, congenital tracheal stenosis associated with congenital heart defect, acquired lesions subsequent to the congenital heart defect resulting from external compression by anomalous or dilated vessels, and acquired lesions resulting from the cardiac operation (tracheal intubation, surgical procedure, etc).

The currently available diagnostic tools are tracheobronchoscopy (with rigid or flexible bronchoscope), tracheobronchography, computed tomographic scan, and magnetic resonance imaging. Tracheobronchoscopy with a rigid bronchoscope probably provides the most extensive information on the localization and extension of the airway obstruction as well as on the presence, localization, and type (pulsatility) of extrinsic compression.

With regard to the two reported cases, left bronchial compression by the left pulmonary artery after arterial switch operation can occur because of extrinsic compression due to poor mobilization of the pulmonary arteries, if the Lecompte maneuver has not been performed as described and required, with extensive mobilization of both pulmonary arteries including their bifurcation, with division (and not ligation) of the patent ductus arteriosus. The level of transection of the pulmonary artery must also be considered, because a high level of transection should reduce the risk of left bronchial compression.

The available options for treatment (conservative versus surgical treatment, timing and type of surgery, etc) should take into consideration the risks associated with prolonged airway compression (tracheobronchomalacia) and with prolonged mechanical ventilation or tracheostomy in infancy. Surgical relief of the airway obstruction seems generally the preferable option.

Related Article

Uncommon complication of arterial switch operation: tracheobronchial compression

Alper Toker, Emin Tireli, Korkut Bostanci, Vural Özcan, and Enver Dayioglu
Ann. Thorac. Surg. 2000 69: 927-929. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Antonio F. Corno Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Corno, A. F. Search for Related Content PubMed Articles by Corno, A. F. Related Collections Related Article