新生児血管輪の1治験例

概要

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A twentyone-day-old boy with vascular ring was successfully treated. He had received a repair of tracheoesophageal fistula at the age of three days. Because of persistent respiratory distress postoperatively, bronchoscopy was carried out at the age of 11 days which revealed compression of the trachea and left main bronchus. Angiocardiography showed right aortic arch with aberrant left subclavian artery, persistent dorsal aortic arch and patent ductus arteriosus. The patient was operated upon at the age of 21 days. Left thoracotomy was done and the ductus arteriosus was devided. Then the trachea and esophagus were freed at the site of constriction and above and below it. Postoperative bronchoscopy showed the evidence of tracheomalacia. Aortopexy was performed for the treatment of tracheomalacia at the age of 2 and half months. His respiratory symptoms gradually improved thereafter. We believe that division of the left subclavian artery is not necessary in this type of vascular ring with large PDA, as the respiratory symptoms mainly due to compression of the trachea and bronchus by ductus, and excision of Kommerell's diverticulum is indicated only when the diverticulum is large. If tracheomalacia is present, aortopexy is recommended for the relief of tracheoesophageal compression in infant.
日本小児外科学会の論文
1983-02-20