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      Double aortic arch as a source of airway obstruction in a child

      case-report

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          Abstract

          Double aortic arch (DAA) is a congenital vascular anomaly. The diagnosis was difficult till the child was symptomatic, and other causes were ruled out. We present the interesting images of a child of respiratory distress because of tracheal compression from DAA.

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          Vascular ring: tracheoesophageal compression associated with symmetrical double aortic arch.

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            Airway management in an infant with double aortic arch.

            A 2-month old male was admitted due to repeated cyanotic attacks. He had suffered from stridor and retractive breathing since birth. Double aortic arch was diagnosed and the vascular ring formed by the double aortic arch was compressing the trachea. Multirow detector computed tomography showed that he had a right-dominant double aortic arch with left ductus arteriosus and an aberrant left subclavian artery, and that the narrowest part of the trachea, where the diameter was 2.0 mm, was located 9.0 mm above the carina. Airway management in patients with extreme narrowing of the trachea is challenging for anesthesiologists. He was scheduled for ligation and division of the left aortic arch and ductus arteriosus. In the operating theater, anesthesia was slowly induced with sevoflurane (0-4%) in oxygen. After mask ventilation was confirmed to be adequate, a 4.0 mm internal diameter endotracheal tube (ETT) was inserted and advanced smoothly beyond the tracheal stenosis. The tip of the ETT was placed just above the carina using a fiber optic bronchoscope (fiberscope) that was passed through the ETT. Since mechanical ventilation was adequate, vecuronium was administered. Surgery was conducted in the right lateral position and using a left thoracotomy approach. Anesthesia was maintained with sevoflurane (2-3%). After positioning, right one-lung ventilation was performed unexpectedly. However, anesthetic management was achieved without difficult ventilation during surgery. The tip of the ETT was pulled past the stenotic part before transfer to the intensive care unit (ICU). A patent trachea during spontaneous breathing under CPAP (5 and 2 cmH(2)O) was confirmed with a bronchofiberscope in the ICU. After weaning from mechanical ventilation, he had the persistence of mild stridor despite improvement of respiratory symptoms.
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              Balanced double aortic arch with tetralogy of Fallot

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                Author and article information

                Journal
                Ann Card Anaesth
                Ann Card Anaesth
                ACA
                Annals of Cardiac Anaesthesia
                Medknow Publications & Media Pvt Ltd (India )
                0971-9784
                0974-5181
                Jan-Mar 2015
                : 18
                : 1
                : 111-112
                Affiliations
                [1]Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
                [1 ]Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
                Author notes
                Address for correspondence: Dr. Sambhunath Das, Department of Cardiac Anaesthesia, Cardio Thoracic Sciences Center, All India Institute of Medical Sciences, 7 th Floor, Ansari Nagar, New Delhi - 110 029, India. E-mail: sambhunathds833@ 123456gmail.com
                Article
                ACA-18-111
                10.4103/0971-9784.148336
                4900311
                25566726
                3a3b956a-5717-4d25-8f06-4a17500e8a99
                Copyright: © 2015 Annals of Cardiac Anaesthesia

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 30 November 2014
                : 16 December 2014
                Categories
                Heart to Heart Blog

                airway obstruction,anesthesia management,children,double aortic arch,vascular ring

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