Rivilla F, Utrilla J G, Alvarez F
Department of Surgery, La Paz Children's Hospital, Madrid, Spain.
Z Kinderchir. 1989 Aug;44(4):199-202. doi: 10.1055/s-2008-1043234.
Thirty patients with aortic arch anomalies resulting in tracheo-oesophageal compression were treated during the period 1966 through 1987. These anomalies are important causes of upper respiratory and oesophageal obstruction in babies and small children. Although symptoms started within the first months of life in most cases, only 15 underwent surgery before six months and a delay of more than one year occurred in 5. Diagnosis was established by chest roentgenogram, barium oesophagogram and angiography. Thirteen (43%) patients had a double aortic arch, 9 (30%) cases had aberrant right subclavian artery and 6 (20%) patients had right aortic arch with ductus or ligamentum arteriosum. One (3.5%) patient had pulmonary artery sling and 1 (3.5%) case had right aortic arch and ductus arteriosum and aberrant right subclavian artery. Associated malformations were seen in 8 (27%) cases, (4 ventricular septal defects, 1 atrial septal defect, 1 coarctation of the aorta, 1 hypoplasia of left pulmonary artery, 1 left diaphragmatic eventration). Basic surgical procedure includes exposure through a left thoracotomy, complete identification of the anomaly and division of the constricting ring. 85% of the patients are asymptomatic and minimal to moderate stridor persists among the remainder. Severe tracheomalacia was responsible for the only two deaths in the series.
1966年至1987年期间，对30例因主动脉弓异常导致气管食管受压的患者进行了治疗。这些异常是婴幼儿上呼吸道和食管梗阻的重要原因。虽然大多数病例症状在出生后的头几个月内就开始出现，但只有15例在6个月前接受了手术，5例出现了超过1年的延误。通过胸部X线片、食管钡餐造影和血管造影确诊。13例（43%）患者为双主动脉弓，9例（30%）为迷走右锁骨下动脉，6例（20%）患者为右主动脉弓伴动脉导管或动脉韧带。1例（3.5%）患者为肺动脉吊带，1例（3.5%）为右主动脉弓、动脉导管和迷走右锁骨下动脉。8例（27%）病例伴有其他畸形（4例室间隔缺损、1例房间隔缺损、1例主动脉缩窄、1例左肺动脉发育不全、1例左膈膨升）。基本手术步骤包括通过左胸切口暴露、完全识别异常并切断狭窄环。85%的患者无症状，其余患者有轻度至中度喘鸣。严重气管软化是该系列中仅有的两例死亡原因。
