The right-sided aortic arch in children with oesophageal atresia and tracheo-oesophageal fistula
| Autor: | J.A. Wood, R. Carachi |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Aortic arch
Male medicine.medical_specialty Fistula medicine.medical_treatment Aorta Thoracic Comorbidity medicine.artery medicine Prevalence Humans Abnormalities Multiple Thoracotomy Esophageal Atresia Retrospective Studies Ultrasonography business.industry Aortic Arch Syndromes Incidence Infant Newborn Infant Retrospective cohort study Right-sided aortic arch Laryngeal cleft medicine.disease Prognosis Surgery Scotland Oesophageal atresia and tracheo-oesophageal fistula Atresia Pediatrics Perinatology and Child Health Female Radiology medicine.symptom business Tracheoesophageal Fistula |
| Zdroj: | European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie. 22(1) |
| ISSN: | 1439-359X |
| Popis: | Aim A right-sided aortic arch (RAA) occurs in around 5% of patients with oesophageal atresia and tracheo-oesophageal fistula (OA/TOF). This anatomical variation can complicate the operative management of these patients, as it is often not diagnosed preoperatively but only discovered at thoracotomy, and it remains unproven as to whether a right or left thoracotomy is the best operative approach. This retrospective study aimed to determine the prevalence of RAA in OA/TOF, review the accuracy of preoperative investigations, and investigate the best operative approach, by reviewing the literature and our own patient series. Methods The case notes of all infants with OA/TOF over a 15 year period (1994–2008) were retrospectively analysed to identify those with a RAA. Birth weight, gestational age, associated anomalies, preoperative investigations, surgical management, postoperative complications and long-term prognosis were all extracted. Main Results A total of 107 case notes of OA/TOF infants were reviewed, identifying 4 with a RAA. Preoperative echocardiography was performed in all of the 4 RAA infants, but RAA was only identified in one. All 4 infants were managed surgically via a right thoracotomy, regardless of the echocardiography result, with primary anastomosis achieved successfully in all. A laryngeal cleft repair was performed in 1 infant due to an interarytenoid cleft. Laparoscopic fundoplication was performed in 1 patient, because of severe gastro-oesophageal reflux. There were no postoperative anastomotic leaks, bleeding, or deaths in this group. Conclusion In our study, the incidence of RAA in OA/TOF was 3.7%. Preoperative echocardiography identified the RAA in only 1 of 4 cases. However, echocardiography was helpful for diagnosing other cardiac anomalies, which might have potentially affected the management of these patients. Previous studies have cited the operative difficulties associated with RAA and OA/TOF. However, in this series of 4 infants, primary anastomosis was achieved via conventional right thoracotomy without complication, and with no effect on outcome or prognosis. Therefore, we conclude that, where possible, a conventional right-sided thoracotomy should be performed in OA/TOF patients with a RAA. |
| Databáze: | OpenAIRE |
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