The effect of a right-sided aortic arch on outcome in children with esophageal atresia and tracheoesophageal fistula

J Pediatr Surg. 2006 Mar;41(3):479-83. doi: 10.1016/j.jpedsurg.2005.10.051.

Abstract

During repair of an esophageal atresia with tracheoesophageal fistula (EA/TEF), a right-sided aortic arch (RAA) presents a technical challenge. We reviewed our experience with EA/TEF focusing on the impact of RAA.

Methods: A retrospective review of patients with EA/TEF at our institution from 1990 to 2004 was performed. Of 61 patients, 53 had a left aortic arch (LAA) and 8 had RAA.

Results: The mean gestational age and birth weight were similar between patients with LAA and RAA. There were more vascular rings in patients with RAA than with LAA (37.5% vs 3.8%, P = .009). A preoperative echocardiogram correctly identified the location of the arch in all with LAA but only 62.5% of those with RAA. Operative complications occurred in 25% of patients with RAA and 11% of patients with LAA.

Conclusions: Management of a child with RAA and EA/TEF is technically challenging. Preoperative identification of the great vessel anomalies may impact operative decision making. Therefore, careful diagnostic evaluation of a patient with an aortic arch that cannot be easily defined by ECHO should be considered before definitive repair.

MeSH terms

  • Aorta, Thoracic / abnormalities*
  • Aorta, Thoracic / surgery*
  • Birth Weight
  • Esophageal Atresia / surgery*
  • Female
  • Humans
  • Infant, Newborn
  • Male
  • Postoperative Complications
  • Retrospective Studies
  • Tracheoesophageal Fistula / surgery*
  • Treatment Outcome