Esophageal-aortic erosion associated with double aortic arch and tracheomalacia: Experience with 2 infants

H. A. Heck, H. V. Moore, W. A. Lutin, L. Leatherbury, E. J. Truemper, C. M. Steinhart, A. L. Pearson-Shaver

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Patients with double aortic arch may require lengthy intubation for ventilatory support. The need for endotracheal and nasogastric intubation may be prolonged in such patients because of associated tracheomalacia. Iatrogenic tracheal or esophageal erosion with subsequent aortic fistulization is an unusual but catastrophic complication that may result from such intubation. We report the cases of 2 infants with double aortic arch and tracheomalacia who developed iatrogenic esophageal-aortic erosion. This complication was successfully managed in 1 of the infants. We conclude from our experience that the important steps in preventing this complication include 1) expediting the exclusion of upper-airway compromise in intubated infants who have a presentation characteristic of bronchospastic airway disease (hyperinflation and hypercapnia) that seems unresponsive to usual therapeutic measures; and 2) expediting the diagnosis of vascular ring in order to minimize the duration of dual tracheal and esophageal intubation. Effective management of this problem, once established, requires primary closure of the esophageal perforation, removal of the nasogastric tube, interposition of thick viable tissue between the esophagus and the aorta, and decompressive gastrostomy and feeding jejunostomy. Concomitant aortopexy may be appropriate.

Original languageEnglish (US)
Pages (from-to)126-129
Number of pages4
JournalTexas Heart Institute Journal
Volume20
Issue number2
StatePublished - Jan 1 1993

Keywords

  • Aorta, thoracic/aortic arch
  • aortic arch syndromes
  • cartilage diseases
  • double aortic arch
  • esophageal diseases
  • esophagus/intubation
  • infant, newborn
  • tracheal diseases
  • vascular ring

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Heck, H. A., Moore, H. V., Lutin, W. A., Leatherbury, L., Truemper, E. J., Steinhart, C. M., & Pearson-Shaver, A. L. (1993). Esophageal-aortic erosion associated with double aortic arch and tracheomalacia: Experience with 2 infants. Texas Heart Institute Journal, 20(2), 126-129.