Vascular anomalies compressing the oesophagus and trachea.

Vascular rings formed by anomalies of major arteries can compress the trachea and oesophagus so much as to cause respiratory distress and dysphagia. Twenty-nine patients with this condition are reviewed and discussed in five groups. The symptoms and signs are noted. Radiological examination by barium swallow is the most useful diagnostic aid. Symptoms can only be relieved by operation. The trachea is often deformed at the site of the constricting ring. Only infrequently is there immediate relief from the pre-operative symptoms. Two babies were successfully treated for an aberrant left pulmonary artery. The diagnosis and treatment of major arterial anomalies which cause compression of the oeso-phagus and trachea are now well established. Although an aberrant right subclavian artery was described in 1794 by Bayford (Fig. 1), who gave the detailed post-mortem finding in a woman who had died from starvation secondary to this anomaly, and a double aortic arch was described by von Siebold (1837), it was not until 1945 that Gross successfully divided a double aortic arch in a 4-month-old infant. Following this success the diagnosis and treatment of this and similar anomalies became firmly established. MATERIAL The surgical experience will be discussed of 29 patients treated consecutively during a 15-year period from 1952 to 1967 at the Hospital for Sick Children, Great Ormond Street, London. The embryology and classification of suoh anomalies are not discussed because we have nothing to add The anomalies are discussed under the following headings: Double aortic arch Right aortic arch in conjunction with a left ligamentum arteriosum or persistent ductus arteriosus Aberrant subclavian artery Aberrant left pulmonary artery Abnormally placed innominate artery DOUBLE AORTIC ARCH Nineteen children were treated for some form of double aortic arch. Their age at operation ranged from 1 week to 11 months, but the majority were treated at about the age of 5 to 6 months (Fig. 2). Frequently the presenting symptoms had been noticed since birth but for varying reasons there was delay in making the correct diagnosis. Stridor, dysphagia or poor feeding , cyanotic attacks, and recurrent respiratory tract infections were the four main presenting symptoms. All but two patients had respiratory stridor and in seven of these children there was concomitant dysphagia or poor feeding. Six children had frequent respiratory tract infections. Initially, some children had bronohoscopy performed in the mistaken belief that they had primary laryngeal or tracheal disease. Plain radio-graphs of the chest …