Airway Obstruction in Aortic Arch Anomalies

Tracheoesophageal compression by aortic arch anomalies is rare. Nevertheless, one must keep this entity in mind because it is associated with significant morbidity. Although it is generally agreed that the barium swallow shows when an abnormal vessel is compressing the esophagus, the literature disagrees on whether a bronchoscopy is needed in the evaluation of these patients. Not uncommonly the symptoms of airway obstruction persist after surgery resolves the anatomic defect. To provide a basis for postoperative comparison, we propose that all patients with suspected aortic arch anomalies undergo endoscopy just before their operation. A series of 26 cases of aortic arch anomalies affecting the airway, seen over a period of 29 years, is presented. A discussion of the clinical presentation, the diagnostic and bronchoscopic findings, and the results of surgical treatment are presented in addition to a brief embryologic and anatomic discussion. A case illustrating the value of preoperative and postoperative bronchoscopy is presented.