Abstract
This report describes a 2-month-old male infant with a double aortic arch (DAA) complicated by aortoesophageal fistula (AEF) and aortotracheal fistula (ATF). He was intubated with an endotracheal tube at birth because of neonatal asphyxia. A nasogastric tube was also placed for gastric decompression and milk feeding. On the 74th day of birth, he had massive upper gastrointestinal hemorrhage associated with shock, and was referred to our hospital. Although emergent surgery controlled the bleeding from AEF, he suffered cardiac arrest due to massive bleeding from ATF 5 h after surgery, and died on the 9th postoperative day. Physicians should be aware that prolonged endotracheal and nasogastric intubation predispose to the development of not only esophageal erosion but also more lethal tracheal erosion. In addition to the importance of early diagnosis and prompt surgery for DAA, appropriate preoperative respiratory management is emphasized to prevent similar occurrences in the future.
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Arciniegas E, Hakimi M, Hertzler JH, Farooki ZQ, Green EW. Surgical management of congenital vascular rings. J Thorac Cardiovasc Surg. 1979;77:721–7.
Chun K, Colombani PM, Dudgeon DL, Haller JA. Diagnosis and management of congenital vascular rings: a 22-year experience. Ann Thorac Surg. 1992;53:597–603.
Mckeating J, Smith S, Kochanck P, Perper J, Orenstein S, Nakayama D. Fatal aortoesophageal fistula due to double aortic arch: an unusual complication of prolonged nasogastric intubation. J Pediatr Surg. 1990;25:1298–300.
Yahagi N, Nishikawa A, Sai Y, Matsui J, Amakata Y. Double aortic arch presenting as massive haematemesis after removal of a nasogastric tube. Can J of Anaesth. 1992;39:894.
Heck HA, Moore HV, Lutin WA, Leatherbury L, Truemper EJ, Steinhart CM, et al. Esophageal-aortic erosion associated with double aortic arch and tracheomalacia. Experience with 2 infants. Tex Heart Inst J. 1993;20:126–9.
Sigalet DL, Laberge JM, DiLorenzo M, Adolph V, Nguyen LT, Youssef S, et al. Aortoesophageal fistula: congenital and acquired causes. J Pediatr Surg. 1994;29:1212–4.
Mizushima A, Sakai H, Hanzawa K, Horimoto Y. Unexpected intraoperative respiratory distress; an infant who developed tracheomalacia and fatal aortoesophageal fistula due to unrecognized vascular ring. Masui. 1995;44:1000–4.
Othersen HB, Khalil B, Zellner J, Sade R, Handy J, Tagge EP, et al. Aortoesophageal fistula and double aortic arch: two important points in management. J Pediatr Surg. 1996;31:594–5.
Angelini A, Dimopoulos K, Frescura C, Gamba P, Lo Piccolo R, Stellin G, et al. Fatal aortoesophageal fistula in two cases of tight vascular ring. Cardiol Young. 2002;12:172–6.
Chaikitpinyo A, Panamonta M, Sutra S, Tontisirin C, Srinakarin J, Wongswadiwat Y. Aortoesophageal fistula: a life-threatening cause of upper gastrointestinal hemorrhage in double aortic arch, a case report. J Med Assoc Thai. 2004;87:992–5.
van Woerkum F, Bont L, Haas F, Freund M, van Gestel S. Aortoesophageal fistula due to double aortic arch and prolonged nasogastric intubation: case report and review of the literature. Eur J Pediatr. 2006;165:660–1.
D’Angelis AR, Questa H, Prieto F, Laundry L, Charroqui A. Successful surgical treatment of a 4-month infant after exsanguination for aortoesophageal fistula. J Pediatr Surg. 2006;41:848–9.
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Atsumi, N., Matsubara, M., Kimura, N. et al. Fatal aortotracheal fistula combined with aortoesophageal fistula in an infant with double aortic arch: a warning. Gen Thorac Cardiovasc Surg 63, 579–582 (2015). https://doi.org/10.1007/s11748-013-0318-1
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DOI: https://doi.org/10.1007/s11748-013-0318-1