The effect of a right-sided aortic arch on outcome in children with esophageal atresia and tracheoesophageal fistula |
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Authors: | Allen Steven R Ignacio Romeo Falcone Richard A Alonso Maria H Brown Rebeccah L Garcia Victor F Inge Thomas H Ryckman Frederick C Warner Brad W Azizkhan Richard G Tiao Gregory M |
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Affiliation: | Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA |
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Abstract: | During repair of an esophageal atresia with tracheoesophageal fistula (EA/TEF), a right-sided aortic arch (RAA) presents a technical challenge. We reviewed our experience with EA/TEF focusing on the impact of RAA.MethodsA retrospective review of patients with EA/TEF at our institution from 1990 to 2004 was performed. Of 61 patients, 53 had a left aortic arch (LAA) and 8 had RAA.ResultsThe mean gestational age and birth weight were similar between patients with LAA and RAA. There were more vascular rings in patients with RAA than with LAA (37.5% vs 3.8%, P = .009). A preoperative echocardiogram correctly identified the location of the arch in all with LAA but only 62.5% of those with RAA. Operative complications occurred in 25% of patients with RAA and 11% of patients with LAA.ConclusionsManagement of a child with RAA and EA/TEF is technically challenging. Preoperative identification of the great vessel anomalies may impact operative decision making. Therefore, careful diagnostic evaluation of a patient with an aortic arch that cannot be easily defined by ECHO should be considered before definitive repair. |
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Keywords: | Esophageal atresia Tracheoesophageal fistula Right-sided aortic arch |
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