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Video Presentation - 16
THORACOSCOPIC DIVISION OF DOUBLE AORTIC ARCH RINGS IN CHILDREN
N Dessouky*, A AlQahtani**, M El Barbary*
*Cairo University Faculty of Medicine , Pediatric Surgical Division, Cairo University Specialized Pediatric Hospital, Egypt
**Division of Pediatric Surgery, Department of Surgery, King Khalid University Hospital and College of Medicine. King Saud University, Riyadh, Saudi Arabia
BACKGROUND:
Double aortic arch (DAA) vascular rings in children are uncommon anomalous malformation which encircle and may compress the airway and esophagus producing symptoms. They are traditionally corrected by open surgery with very few reports concerned with the use of minimally invasive approach in children.
Aim and Objectives :
The objectives were to evaluate the effectiveness, advantages and safety of thoracoscopy in children for division of DAA vascular rings.
MATERIAL AND METHODS:
Two cases of DAA were studied in the Specialized Pediatric Hospitals of Benha and Cairo University from April 2008 and June 2010. Both cases were females aged 4 months (case-1) and 5 years (case-2). Symptoms of tracheal compression were present in both cases while dysphagia was evident in the later. Esophagogram showed posterior compression of the esophagus in both cases being more evident in case-2.Computed tomography scan with 3D axial reconstruction visualized the vascular anomaly with the right arch being dominant in case-2 and both arches were equal sized in case-1. Preoperative airway endoscopy was performed in case-1. Thoracosopic division was applied for both cases.
RESULTS:
Thoracoscopy was approached from the left side with division of the anomalous left arch distal to the left subclavian vessels in both cases. Double clips were applied to each side of the vessel ends in case-1 while addition ligature was performed for reinforcement in case-2. The average operative time 90 minutes in both cases. Postoperative ventilator support was needed for 3 days in case-1. The average hospital stay was 5 days with improvement of symptoms within one month in both cases.
CONCLUSIONS:
Thoracoscopy can be a safe and effective approach for division of DAA in children with the advantages of rapid convalescence, reduced pain and better cosmetic results.