Application of descending aortic translocation in tracheal or bronchial stenosis due to aortic deformity / 中华胸心血管外科杂志

ABSTRACT

Objective:To investigate the efficacy of descending aortic translocation in relieving the compression of trachea or bronchus caused by aortic deformity.Methods:From January 2017 to July 2019, a total of 11 patients with distal trachea or proximal bronchial stenosis caused by aortic deformity were treated with descending aortic translocation. Cardiac CT and fiberoptic bronchoscopy were performed before surgery. The median age was 55(23-540) days, and the body weight was 4(2.1-9.0)kg. Five patients had a special type of vascular ring(left aortic arch with right descending aorta, small aortic window with funnel chest; left aortic arch with right descending aorta and right artery ligament, vagus right subclavian artery, combined with trachea, carina and left and right bronchial stenosis in 1 case; Right aortic arch with left descending aorta, combined with tracheomalacia stenosis in 1 case; Right aortic arch with left descending aorta combined with broad tracheal stenosis and left pulmonary dysplasia in 1 case) compressed tracheal or bronchial tube in 5 cases. Three patients with left main bronchus constriction after traditional arch disconnection surgery. 3 patients with left main bronchus stenosis before coarctation or interrupted aortic arch.Surgical methods: Descending aortic translocation was performed through a midline sternotomy with cardiopulmonary bypass and deep hypothermia.The proximal descending aorta was transected distal to the left subclavian artery, proximal sutures were performed, and the distal brought up though the transverse sinus caudad to the right pulmonary artery and tracheal carina, and anastomosed in end-to-end fashion to the ascending aorta, and simultaneous correction was performed with intracardiac malformations, such as airway plasty was performed at the same time without improvement after compression of tracheal stenosis.Results:There was no death in the whole group. Median cardiopulmonary bypass was 180(136-337)min with an median aortic cross-clamp time of 51(30-84)min; Median absence of perfusion to the descending thoracic aorta 34(21-50)min .Tracheal compression was effectively relieved in 5 patients, and airway plasty was performed simultaneously in 6 patients due to persistent tracheal softening and stenosis. All patients had resolution of symptoms.There was only one case anastomotic stenosis after descending aortic translocation.The mean follow-up was(18.0±9.4)months.Conclusion:Descending aortic translocation can effectively relieve this kind of pressure due to aortic deformity.