The frequency, significance, and management of a right aortic arch in association with esophageal atresia

被引:19
作者
Bowkett, B
Beasley, SW
Myers, NA
机构
[1] Royal Childrens Hosp, Dept Surg, Parkville, Vic 3052, Australia
[2] Wellington Hosp, Dept Surg, Wellington, New Zealand
关键词
oesophageal atresia; aortic arch; tracheo-oesophageal fistula; congenital heart disease;
D O I
10.1007/s003830050505
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
An unrecognised right aortic arch (RAA) found at thoracotomy may complicate the repair of oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF). This paper analyses the patient characteristics. peri-operative management, and outcome of 16 infants with a RAA, and proposes management guidelines. Between 1948 and 1996, 709 patients with OA/TOF were admitted to the Royal Children's Hospital. of whom 13 had a RAA. Three additional cases from two other paediatric surgical units were included. All 16 case records were reviewed retrospectively. The overall incidence of RAA in OA was 1.8%. Neither a chest radiograph in 16, nor antenatal ultrasonography in 7 detected a RAA. Post-natal echocardiography (ECHG) detected a RAA in only 1 of 7 infants examined: that patient underwent repair of the OA through a left (L) thoracotomy. The other 15 infants underwent initial right (R) thoracotomy. Six of these had a complete repair fi om the R side and 5 had division of the fistula only; 2 of these 5 had initial division of the fistula. and the OA was repaired through a repeat R thoracotomy 4 and 7 weeks later. In the remaining 4 infants where the fistula could not be located at the initial R thoracotomy. complete repair proved possible through the L chest. Three of these infants underwent an immediate L thoracotomy: the 4th had a delayed L thoracotomy week later. There were 6 deaths: these occurred early in the study and were related to severe prematurity, congenital heart disease (CHD), and post-operative respiratory complications. CHD was identified in 11 of 16 infants (71%). Routine pre-operative ECHG is unreliable in determining the laterality of the aortic arch. Should a RAA be encountered during a R thoracotomy for OA, it is often possible to divide the fistula and repair the OA from that side, but where repair looks potentially difficult it is wise to proceed to an immediate L thoracotomy.
引用
收藏
页码:28 / 31
页数:4
相关论文
共 20 条
[1]  
BURDON WE, 1979, J PEDIATR SURG, V14, P436
[2]   MAGNETIC-RESONANCE-IMAGING OF THE PEDIATRIC THORACIC AORTA [J].
BURROWS, PE ;
MACDONALD, CE .
SEMINARS IN ULTRASOUND CT AND MRI, 1993, 14 (02) :129-144
[3]   DIAGNOSIS AND MANAGEMENT OF CONGENITAL VASCULAR RINGS - A 22-YEAR EXPERIENCE [J].
CHUN, K ;
COLOMBANI, PM ;
DUDGEON, DL ;
HALLER, JA .
ANNALS OF THORACIC SURGERY, 1992, 53 (04) :597-603
[4]   ANOMALOUS MIDLINE LOCATION OF THE DESCENDING AORTA - A CAUSE OF COMPRESSION OF THE CARINA AND LEFT MAINSTEM BRONCHUS IN INFANTS [J].
DONNELLY, LF ;
BISSET, GS ;
MCDERMOTT, B .
AMERICAN JOURNAL OF ROENTGENOLOGY, 1995, 164 (03) :705-707
[5]   ESOPHAGEAL ATRESIA AND ASSOCIATED ANOMALIES [J].
GERMAN, JC ;
MAHOUR, GH ;
WOOLLEY, MM .
JOURNAL OF PEDIATRIC SURGERY, 1976, 11 (03) :299-306
[6]   SIGNIFICANCE OF RIGHT AORTIC-ARCH IN REPAIR OF ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL FISTULA [J].
HARRISON, MR ;
HANSON, BA ;
MAHOUR, GH ;
TAKAHASHI, M ;
WEITZMAN, JJ .
JOURNAL OF PEDIATRIC SURGERY, 1977, 12 (06) :861-869
[7]  
HARRISON R, 1980, J PEDIATR SURG, V15, P312
[8]   SPIRAL CT AND 3D IMAGE-RECONSTRUCTION OF VASCULAR RINGS AND ASSOCIATED TRACHEOBRONCHIAL ANOMALIES [J].
KATZ, M ;
KONEN, E ;
ROZENMAN, J ;
SZEINBERG, A ;
ITZCHAK, Y .
JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY, 1995, 19 (04) :564-568
[9]   RIGHT AORTIC-ARCH - TYPES AND ASSOCIATED CARDIAC ANOMALIES [J].
KNIGHT, L ;
EDWARDS, JE .
CIRCULATION, 1974, 50 (05) :1047-1051
[10]   ECHOCARDIOGRAPHY IN THE PREOPERATIVE EVALUATION OF VASCULAR RINGS [J].
LILLEHEI, CW ;
COLAN, S .
JOURNAL OF PEDIATRIC SURGERY, 1992, 27 (08) :1118-1121