E. Dean McKenzie, MD, Mark E. Roeser, MD, Jess L. Thompson, MD, Luis E

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Presentation transcript:

Descending Aortic Translocation for Relief of Distal Tracheal and Proximal Bronchial Compression E. Dean McKenzie, MD, Mark E. Roeser, MD, Jess L. Thompson, MD, Luis E. De León, MD, Iki Adachi, MD, Jeffrey S. Heinle, MD, Carlos M. Mery, MD, MPH, Charles D. Fraser, MD The Annals of Thoracic Surgery Volume 102, Issue 3, Pages 859-862 (September 2016) DOI: 10.1016/j.athoracsur.2016.02.044 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Anatomic relationship of the aorta to the airway causing proximal bronchial compression. The descending thoracic aorta traverses the midline and is located between the spine and left main bronchus (LB). (Asc Ao = ascending aorta; Desc Ao = descending aorta; RA = right atrium; RPA = right pulmonary artery.) The Annals of Thoracic Surgery 2016 102, 859-862DOI: (10.1016/j.athoracsur.2016.02.044) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Preoperative and postoperative computed tomography scans of patient 1. (A) Preoperative scan showed a left aortic arch with significant compression of the left main bronchus and carina by an abnormal descending thoracic aorta crossing the midline, immediately posterior to the left bronchus. (B) In postoperative imaging, left main bronchus caliber is improved after aortic translocation inferior to the carina. The Annals of Thoracic Surgery 2016 102, 859-862DOI: (10.1016/j.athoracsur.2016.02.044) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Changes in anatomic relationship of the aorta to the airway after repair. The descending aorta (Desc Ao) has been mobilized inferior to the tracheal carina and pulmonary artery, and an end descending–to–side ascending aortic anastomosis has been performed. (Asc Ao = ascending aorta; LB = left bronchus; RA = right atrium; RPA = right pulmonary artery.) The Annals of Thoracic Surgery 2016 102, 859-862DOI: (10.1016/j.athoracsur.2016.02.044) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) Preoperative and (B) postoperative three-dimensional reconstructions of a patient’s computed tomography scans that demonstrate the translocated descending thoracic aorta, now inferior to the tracheal carina, which is not shown. The Annals of Thoracic Surgery 2016 102, 859-862DOI: (10.1016/j.athoracsur.2016.02.044) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions