気管軟化症を合併した新生児重複大動脈弓の1治験例

概要

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A tweleve-day-old male neonate was referred to University of Tsukuda because of dyspnea necessitating endotracheal intubation and ventilation soon after birth. He was suspected of having vascular ring by esophagography. Angiography confirmed the diagnosis of double aortic arch (Stewart & Edwards classification IA). On the fourteenth day after birth, the anterior aortic arch was divided just distal to the left subclavian artery and suspended to the anterior chest wall through left thoracotomy. Bronchoscopy performed after the procedures revealed severe tracheomalcia. In spite of the definitive operation, he could not be weaned from a respirator. After a few unsuccessful attempts to extubate. the second operation was performed 15 days after the first operation. At that operation, the ascending aorta and the right aortic arch were suspended to the 2nd, 3rd rib and sternum under direct vision by bronchoscopy. He was successfully extubated on the 9th postoperative day. He was discharged in 3 months and has been doing well up to the present. The experiences of this case has suggested : (1) aortopexy is a useful option for tracheomalacia associated with vascular ring, (2) bronchoscopy should be performed in cases of vascular ring with dyspnea to detect the co-exsitent intrinsic airway obstruction.
日本小児外科学会の論文
1989-04-20