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

• Published in: Texas Heart Institute journal 1993, Vol.20 (2), p.126-129
• Main Authors: HECK, H. A, MOORE, H. V, LUTIN, W. A, LEATHERBURY, L, TRUEMPER, E. J, STEINHART, C. M, PEARSON-SHAVER, A. L
• Format: Article
• Language: English
• Subjects: Aorta, Thoracic - abnormalities; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - injuries; Biological and medical sciences; Cardiology. Vascular system; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Esophageal Perforation - diagnostic imaging; Esophageal Perforation - etiology; Female; Fistula - etiology; Heart; Humans; Infant; Infant, Newborn; Intubation, Gastrointestinal - adverse effects; Intubation, Intratracheal - adverse effects; Male; Medical sciences; Radiography; Tracheal Diseases - complications; Tracheal Diseases - congenital; Tracheal Diseases - diagnostic imaging
• ISSN: 0730-2347; 1526-6702

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.