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Cardiovascular causes of tracheobronchial compression: a decade experience in a Paediatric Congenital Heart Centre

Part of: Advanced Imaging

Published online by Cambridge University Press:  03 June 2021

Putri Yubbu Open the ORCID record for Putri Yubbu [Opens in a new window] ,
Haifa Abdul Latiff ,
Husna Musa Open the ORCID record for Husna Musa [Opens in a new window] ,
Navin Kumar Devaraj ,
Nurul Adha Mohd Razif ,
Sivakumar Sivalingam  and
Hasri Samion
Putri Yubbu*
Affiliation:
Department of Paediatric, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
Haifa Abdul Latiff
Affiliation:
Paediatric and Congenital Heart Centre, National Heart Institute Malaysia, Kuala Lumpur, Malaysia
Husna Musa
Affiliation:
Department of Paediatric, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
Navin Kumar Devaraj
Affiliation:
Family Medicine Department, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
Nurul Adha Mohd Razif
Affiliation:
Department of Paediatric, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
Sivakumar Sivalingam
Affiliation:
Cardiothoracic Department, National Heart Institute Malaysia, Kuala Lumpur, Malaysia
Hasri Samion
Affiliation:
Paediatric and Congenital Heart Centre, National Heart Institute Malaysia, Kuala Lumpur, Malaysia
*
Author for correspondence: Putri Yubbu, Department of Paediatric, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia. Tel: +60397692612. E-mail: drputri@upm.edumy
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Abstract

Background:

Vascular compression of the airway often complicates CHD management. This study evaluated the use of CT in determining cardiovascular causes, clinical manifestations, and outcome of tracheobronchial compression among children with CHD.

Methods:

A retrospective review of clinical records of all patients with CT scan evidence of tracheobronchial compression from January 2007 to December 2017 at National Heart Institute. Cardiovascular causes of tracheobronchial compression were divided into three groups; group I: vascular ring/pulmonary artery sling, II: abnormally enlarged or malposition cardiovascular structure due to CHD, III: post-CHD surgery.

Results:

Vascular tracheobronchial compression was found in 81 out of 810 (10%) patients who underwent CT scan. Group I lesions were the leading causes of vascular tracheobronchial compression (55.5%), followed by group II (34.6%) and group III (9.9%). The median age of diagnosis in groups I, II, and III were 16.8 months, 3 months, and 15.6 months, respectively. Half of group I patients are manifested with stridor and one-third with recurrent chest infections. Persistent respiratory symptoms, lung atelectasis, or prolonged respiratory support requirement were clues in groups II and III. Higher morbidity and mortality in younger infants with severe obstructive airway symptoms, associated airway abnormalities, and underlying complex cyanotic CHD.

Conclusions:

Vascular ring/pulmonary artery sling and abnormally enlarged or malposition cardiovascular structure were the leading causes of cardiovascular airway compression. A high index of suspicion is needed for early detection due to its non-specific presentation. The outcome often depends on the severity of airway obstruction and complexity of cardiac lesions.

Keywords

CHDvascular tracheobronchial compressionvascular ringspulmonary slingCT scan
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 3 , March 2022 , pp. 374 - 382
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

McLaren, CA, Elliott, MJ, Roebuck, DJ. Vascular compression of the airway in children. Paediatr Respir Rev 2008; 9: 85–94. doi: 10.1016/j.prrv.2007.12.008.CrossRefGoogle ScholarPubMed
Davis, DA, Tucker, JA, Russo, P. Management of airway obstruction in patients with congenital heart defects. Ann Otol Rhinol Laryngol 1993; 102: 163–166. doi: 10.1177/000348949310200301.CrossRefGoogle ScholarPubMed
Bonnard, A, Auber, F, Fourcade, L, Marchac, V, Emond, S, Révillon, Y. Vascular ring abnormalities: a retrospective study of 62 cases. J Pediatr Surg 2003; 38: 539–543. doi: 10.1053/jpsu.2003.50117.CrossRefGoogle ScholarPubMed
Suh, YJ, Kim, GB, Kwon, BS, et al. Clinical course of vascular rings and risk factors associated with mortality. Korean Circu J 2012; 42: 252–258. doi: 10.4070/kcj.2012.42.4.252.CrossRefGoogle ScholarPubMed
Etesami, M, Ashwath, R, Kanne, J, Gilkeson, RC, Rajiah, P. Computed tomography in the evaluation of vascular rings and slings. Insights Imaging 2014; 5: 507–521. doi: 10.1007/s13244-014-0343-3.CrossRefGoogle ScholarPubMed
An, HS, Choi, EY, Kwon, BS, et al. Airway compression in children with congenital heart disease evaluated using computed tomography. Ann Thorac Surg. 2013; 96: 2192–2197. doi: 10.1016/j.athoracsur.2013.07.016.CrossRefGoogle ScholarPubMed
Woods, RK, Sharp, RJ, Holcomb, GW, et al. Vascular anomalies and tracheoesophageal compression: a single institution’s 25-year experience. Ann Thorac Surg 2001; 72: 434–438; discussion 438–439. doi: 10.1016/s0003-4975(01)02806-5.CrossRefGoogle ScholarPubMed
Knight, L, Edwards, JE. Right aortic arch. Types and associated cardiac anomalies. Circulation 1974; 50: 1047–1051. doi: 10.1161/01.cir.50.5.1047.CrossRefGoogle ScholarPubMed
Park, SC. Symposium on pediatric otolaryngology. Vascular abnormalities. Pediatr Clin North Am. 1981; 28: 949–955.CrossRefGoogle ScholarPubMed
Kussman, BD, Geva, T, McGowan, FX. Cardiovascular causes of airway compression. Paediatr Anaesth 2004; 14: 60–74. doi: 10.1046/j.1460-9592.2003.01192.x.CrossRefGoogle ScholarPubMed
Jhang, WK, Park, J-J, Seo, D-M, Goo, HW, Gwak, M. Perioperative evaluation of airways in patients with arch obstruction and intracardiac defects. Ann Thorac Surg 2008; 85: 1753–1758. doi: 10.1016/j.athoracsur.2008.01.059.CrossRefGoogle Scholar
Peyvandi, S, Lupo, PJ, Garbarini, J, et al. 22q11.2 deletions in patients with conotruncal defects: data from 1,610 consecutive cases. Pediatr Cardiol 2013; 34: 1687–1694. doi: 10.1007/s00246-013-0694-4.CrossRefGoogle ScholarPubMed
Suh, YJ, Kim, GB, Kwon, BS, et al. Clinical course of vascular rings and risk factors associated with mortality. Korean Circ J 2012; 42: 252–258. doi: 10.4070/kcj.2012.42.4.252.CrossRefGoogle ScholarPubMed
Yubbu, P, Devaraj, NK, Sahadan, DZ, Latiff, HA. Vascular compression of the airways: issues on management in children with congenital heart disease. Progress in Pediatric Cardiology 2020; 101207. doi: 10.1016/j.ppedcard.2020.101207.CrossRefGoogle Scholar
Filler, RM, de Fraga, JC. Tracheomalacia. Semin Thorac Cardiovasc Surg 1994; 6: 211–215.Google ScholarPubMed
Yong, MS, Zhu, MZL, Bell, D, et al. Long-term outcomes of surgery for pulmonary artery sling in children. Eur J Cardiothorac Surg 2019. doi: 10.1093/ejcts/ezz012.CrossRefGoogle Scholar