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(Circulation. 2004;109:e308-e309.)
© 2004 American Heart Association, Inc.

Images in Cardiovascular Medicine

Dynamic Assessment of Tracheal Stenosis Due to Double Aortic Arch Using Low-Dose, 16-Slice Computed Tomography

N. Rogalla, MD, RD; R. Wauer, MD; P. Rogalla, MD

From the Departments of Neonatology (N.R., R.W.) and Radiology (P.R.), Charité-Universitätsmedizin Berlin, Campus Charité-Mitte, Berlin, Germany.

Correspondence to Noga E. Rogalla, MD, RD, Klinik für Neonatologie Charité-Universitätsmedizin Berlin, Campus Charité-Mitte, D-13344 Berlin, Germany. E-mail noga.meiri@charite.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A term newborn presented with dyspnea and stridor in the first day of life. Prenatal sonography revealed a suspected double aortic arch without tracheal compression. In the postnatal echocardiogram, vascular details were ambiguous. Respiratory analysis showed increased respiratory and airway resistance. Pre- and postoperative assessment was achieved with low-dose, respiratory-gated, 16-slice computed tomography (CT). Figure 1 displays the compression caused mainly by the right aortic arch (RAA) of the vascular ring. Data were reconstructed to dynamic images displaying the location and extent of tracheal compression throughout the complete breathing cycle (Figure 2; also see video available in the online only Data Supplement at http://www.circulationaha.org). Coronal reconstructions following ligation of the left arch show persistence of tracheal compression (Figure 3); the corresponding respiratory insufficiency necessitated aortopexy of the RAA.

View larger version (135K): [in this window] [in a new window]   Figure 1. Preoperative 3D reconstruction that, after "subtracting" the heart, displays compression (arrow) of the trachea (TC) caused by a vascular ring; the tracheal indentation is caused mainly by the RAA. LAA indicates left aortic arch.

View larger version (169K): [in this window] [in a new window]   Figure 2. Static position of the dynamic, non-contrast, coronal video that depicts the tracheal compression during continuous breathing (also see the online-only Data Supplement).

View larger version (153K): [in this window] [in a new window]   Figure 3. Postoperative, contrast-enhanced coronal reconstruction. Despite ligation of the left aortic arch, persistence of stridor and compression (arrow) necessitated aortopexy of the patent RAA.

Multislice CT offers the benefit of rapid assessment in patients who have respiratory instability or who are undergoing mechanical ventilation. It also depicts vasculature and airway compression despite continuous breathing and provides information . . . [Full Text of this Article]