降主动脉移位术治疗呼吸消化道血管压迫

文献信息

中文摘要

目的： 复杂血管环异常患者可表现为食管和气道压迫症状，有时尽管血管环已解除，仍因主动脉残余压迫而症状持续。我们报告采用降主动脉移位术治疗呼吸消化道血管压迫的早期经验。
方法： 这是一项单中心回顾性研究，纳入接受降主动脉移位术的患者。该手术包括在体外循环下离断远端主动脉弓，将降主动脉移位至隆突和右肺动脉下方，并与升主动脉后壁吻合，从而完全解除对呼吸消化道的压迫。根据需要同期行食管松解和气管固定术。
结果： 2020年至2023年，共有15例患者接受降主动脉移位术。解剖变异包括发夹主动脉（n=2）、环曲主动脉（n=4）、中线降主动脉（n=7）和弓弦主动脉（n=2）。中位年龄为2岁。术前，大多数患者（80%）存在食管和气道混合症状，且至少接受过1次手术（60%）。术中支气管镜检查显示所有患者气道通畅性改善。术后，93%的患者呼吸道症状缓解，79%的患者吞咽困难改善。术后并发症包括神经系统事件（n=1，完全恢复）、右肺动脉压迫需支架置入（n=1）以及需要再次手术（n=2）。
结论： 降主动脉移位术是一种新方法，可缓解与复杂主动脉异常相关的呼吸消化道压迫症状。对于初始血管环修复后症状持续的患者，可能需要处理持续存在的主动脉压迫，这也提出了是否应将降主动脉移位术视为一线治疗的问题。

英文摘要

OBJECTIVE: Patients with complex vascular ring anomalies can present with symptoms of esophageal and airway compression, occasionally persisting despite relief of the vascular ring, due to residual compression from the aorta. We report our early experience with descending aortic translocation to address aerodigestive vascular compression.
METHODS: This is a retrospective single-center review of patients undergoing descending aortic translocation. The operation involves dividing the distal aortic arch on cardiopulmonary bypass, relocating the descending aorta beneath the carina and right pulmonary artery, and anastomosis to the posterior aspect of the ascending aorta, thereby entirely relieving compression on the aerodigestive tract. Concomitant esophageal mobilization and tracheopexies are performed as needed.
RESULTS: From 2020 to 2023, 15 patients underwent descending aortic translocation. Anatomic variants included hairpin aorta (n = 2), circumflex aorta (n = 4), midline descending aorta (n = 7), and bowstring aorta (n = 2). Median age was 2 years. Preoperatively, most patients (80%) had mixed esophageal and airway symptoms and had undergone at least 1 prior operation (60%). Intraoperative bronchoscopy revealed improved airway patency for all patients. Postoperatively, 93% of patients had relief of respiratory symptoms, and 79% of patients had improved dysphagia. Postoperative complications included neurologic event (n = 1) with full resolution, right pulmonary artery compression requiring stenting (n = 1), and need for reoperation (n = 2).
CONCLUSIONS: Descending aortic translocation is a novel approach that can provide symptomatic relief of aerodigestive compression related to complex aortic anomalies. For patients with persistent symptoms after initial vascular ring repair, ongoing aortic compression may need to be addressed, thus also raising the question of whether descending aortic translocation should be considered as a first-line therapy.