Tracheal compression as a cause of apnea following repair of tracheoesophageal fistula: treatment by aortopexy.

Tracheal compression is one of the many causes of apnea following repair of esophageal atresia with tracheoesophageal fistula. Since May, 1977 we have treated eight patients with "dying spells" usually occurring during and following a feeding. These episodes were characterized by cyanosis and bradycardia, which progressed to apnea. Tracheal compression was documented to be the etiology of the apnea spells. Other possible causes such as aspiration from gastroesophageal reflux, recurrent tracheoesophageal fistula and esophageal stricture were eliminated. Eight infants underwent aortopexy that was successful in terminating the apneic episodes in seven patients with an average follow-up of 20 mo. One patient continued to have symptoms from a previously undiagnosed vascular ring which was successfully divided one month following aortopexy. After being asymptomatic for 1 mo this infant died from a cardiorespiratory arrest at home. An autopsy did not reveal the cause. Intermittant tracheal obstruction leading to apneic spells is a life-threatening entity following tracheosophageal fistula repair, which can be corrected by aortopexy.