Vascular anomalies causing tracheoesophageal compression: a 20-year experience in diagnosis and management

Vascular rings and other congenital aortic arch anomalies may be major causes of tracheoesophageal obstruction in children. In this report, our diagnostic approach, surgical treatment, and early and late results for 30 patients are reported. During a 20-year period (1982-2002), 30 children underwent surgery for tracheoesophageal compression caused by aortic arch anomalies. The median age at operation was 8 months (range, 36 days to 94 months), and the median patient weight was 8 kg (range, 2.4-16 kg). At 53.3% of cases, double aortic arch was by far the most common encountered cause of compression. Patients were admitted with respiratory distress, stridor, apnea, dysphagia, or recurrent respiratory tract infections. Diagnosis was established by barium esophagogram, computed tomography, magnetic resonance imaging, and angiography. The operative approaches were through a left thoracotomy or a median sternotomy. Operative mortality rate was 3.3%. Follow-up data from 2 months to 10 years (mean follow-up, 34 weeks) were available for all 30 patients. Twenty-six patients (86.7%) were essentially free of symptoms, 3 patients (10%) had residual respiratory problems, and 1 patient (3.3 %) had a gastroesophageal reflux problem. These results suggest that surgical correction of symptomatic vascular rings can be performed with low mortality and morbidity rates.