International Society For Minimally Invasive Cardiothoracic Surgery

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Circumflex Aorta And The 'Uncrossing' Operation
Raghav Murthy, MBBS, DABS, FACS1, Othman Aljohani, MD2, Matthew Brigger, MD, MPH2, John Lamberti, MD, FACS3.
1Mount Sinai Hospital, New York, NY, USA, 2Rady Children's Hospital, San Diego, CA, USA, 3Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.

OBJECTIVE: To demonstrate the surgical management of a complex vascular ring- the circumflex aorta using the 'Uncrossing' operation to relieve tracheal compression
METHODS: A 9 year old boy (27 kgs) with persistent cough and noisy breathing, had undergone division of a vascular ring and posterior aortopexy through a left thoracotomy. Secondary to persistent symptoms, he later underwent a sternotomy and anterior aortopexy. Bronchoscopy showed tracheobronchomalacia pulsatile posterior tracheal compression. CTA revealed a right aortic arch, mirror image head and neck vessel branching and a left posterior descending aorta constituting a circumflex aorta causing tracheal compression. We performed a redo-sternotomy, an 'uncrossing' operation and an anterior aortopexy. Post operative bronchoscopy showed widely patent airways. The post-operative course was uneventful.
RESULTS: The child is currently completely asymptomatic with significant benifit from the surgery. The photo demonstrates the pre and post operative bronchoscopy.
CONCLUSIONS: Recognition of rare forms of vascular rings causing tracheal compression can be corrected with surgery. The 'uncrossing' operation provides tremendous benefit by relieving tracheal compression caused by a circumflex aorta.

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