Document Detail


Cardiovascular causes of airway compression.
MedLine Citation:
PMID:  14717876     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Compression of the paediatric airway is a relatively common and often unrecognized complication of congenital cardiac and aortic arch anomalies. Airway obstruction may be the result of an anomalous relationship between the tracheobronchial tree and vascular structures (producing a vascular ring) or the result of extrinsic compression caused by dilated pulmonary arteries, left atrial enlargement, massive cardiomegaly, or intraluminal bronchial obstruction. A high index of suspicion of mechanical airway compression should be maintained in infants and children with recurrent respiratory difficulties, stridor, wheezing, dysphagia, or apnoea unexplained by other causes. Prompt diagnosis is required to avoid death and minimize airway damage. In addition to plain chest radiography and echocardiography, diagnostic investigations may consist of barium oesophagography, magnetic resonance imaging (MRI), computed tomography, cardiac catheterization and bronchoscopy. The most important recent advance is MRI, which can produce high quality three-dimensional reconstruction of all anatomic elements allowing for precise anatomic delineation and improved surgical planning. Anaesthetic technique will depend on the type of vascular ring and the presence of any congenital heart disease or intrinsic lesions of the tracheobronchial tree. Vascular rings may be repaired through a conventional posterolateral thoracotomy, or utilizing video-assisted thoracoscopic surgery (VATS) or robotic endoscopic surgery. Persistent airway obstruction following surgical repair may be due to residual compression, secondary airway wall instability (malacia), or intrinsic lesions of the airway. Simultaneous repair of cardiac defects and vascular tracheobronchial compression carries a higher risk of morbidity and mortality.
Authors:
Barry D Kussman; Tal Geva; Francis X McGowan
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Paediatric anaesthesia     Volume:  14     ISSN:  1155-5645     ISO Abbreviation:  Paediatr Anaesth     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2004-01-13     Completed Date:  2004-05-07     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9206575     Medline TA:  Paediatr Anaesth     Country:  France    
Other Details:
Languages:  eng     Pagination:  60-74     Citation Subset:  IM    
Affiliation:
Departments of Anesthesia Cardiology, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA. barry.kussman@tch.harvard.edu
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MeSH Terms
Descriptor/Qualifier:
Airway Obstruction / diagnosis,  etiology*,  surgery,  therapy
Anesthesia, Inhalation*
Aorta, Thoracic / abnormalities
Cardiovascular Diseases / complications*,  physiopathology*,  surgery
Cardiovascular System / embryology
Child
Child, Preschool
Heart Defects, Congenital / complications,  surgery
Heart Diseases / congenital
Humans
Infant
Infant, Newborn
Pulmonary Artery / abnormalities

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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