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A3955 - Corrective Tracheobronchomalacia Surgery: Pre-Surgical Planning and Incidence of Great Vessel and Aberrant Vascular Anomalies
Author Block: W. Svetanoff, S. Bairdain, R. Jennings, C. J. Smithers, S. Prabhu, C. Baird, T. Hamilton; Department of Surgery, Boston Children's Hospital, Boston, MA, United States.
RATIONALE: Tracheobronchomalacia (TBM) may be isolated or associated with other congenital abnormalities, including esophageal atresia, congenital heart defects, and great vessel anomalies. As surgical correction may include displacement of abnormal vasculature compressing the airway, anatomic delineation pre-operatively is imperative for appropriate surgical planning. Our objective was to identify the incidence of great vessel anomalies, aberrant vessels, as well as the level of the Artery of Adamkiewicz (AoA) in these patients to aid in pre-surgical planning. METHODS: We performed a retrospective chart review on patients who obtained a computed tomography (CT) scan of the chest between 04/2001 and 10/2017 where the anatomy of the great vessels was specified (IRB#P00004344). The presence of a right aortic arch, left superior vena cava (SVC), aberrant vessel, innominate artery compression on the trachea, and the level of the AoA were identified, if available. Demographics and the incidence of vascular anomalies in patients undergoing surgical correction of symptomatic TBM were then categorized. RESULTS: Two-hundred and four patients underwent surgery for symptomatic TBM, of which 37% (75/204) had a specific great vessel anomaly. This included 26 right aortic arches, 34 left SVCs, 27 vascular rings, and 70 with an aberrant vessel. Of those with an aberrant vessel, 38.5% (27/70) had bovine arches, 37% (26/70) had an aberrant right subclavian vessel, and 18.5% (13/70) had an aberrant left subclavian vessel (12 were also associated with a right aortic arch). Thirty-four patients had multiple vascular anomalies. Of patients requiring TBM surgery, 10% (21) had right aortic arches, 12% (24) had bilateral SVCs, 10% (20) had a vascular ring, and 25% (70) had an aberrant vessel. Fifty-two patients had isolated innominate artery compression of the trachea, which lead to surgical intervention in 92% of those patients. In 50 patients, the AoA was also identified - the most common location was at T10 and T11 (15 patients each), but was also found has high as T5 and as low as T12. Thirty-seven percent of patients with esophageal atresia that also required correction of TBM had aberrant vasculature.
CONCLUSION: In those patients with symptomatic TBM, up to 37% had great vessel anomalies, which increased to 60% (125/204) when including those with isolated innominate artery compression. Obtaining CT scans of the chest, specifically with 3D reconstruction for the identification of these anomalies and level of AoA, is crucial for operative planning prior to TBM correction to optimize intraoperative and postoperative outcomes.