Tevfik DEMİR, Pelin KÖŞGER, Gökmen ÖZDEMİR, Ali YILDIRIM, Birsen UÇAR, Zübeyir KILIÇ

Vasküler Halka Nedeniyle Solunum Arresti Gelişen İnfant: Ayna Görüntüsü Dallanması ile Sağ Arkus Aorta ve Sol Ligamentum Arteriosum

Vasküler halka aortik ark ve pulmoner arterin, trakea ve özefagusa değişenderecelerde bası yaparak solunum ve beslenme problemlerine neden olabilen biranomali grubudur. En sık saptanan tipi double aortik arktır. Hastalarda değişenşiddetlerde öksürük, dispne, inspiratuvar stridor, disfaji ve solunum yetersizliğigörülür. Solunum güçlüğü, hırıltılı solunum ve öksürük nedeniyle başvurduğuhastanede pnömoni tanısı konan 15 günlük erkek bebek hasta yatırılmış.Antiobiyotik tedavisi başlanan hasta şikayetlerinin gerilememesi ve solunumarresti gelişmesi üzerine tarafımıza yönlendirildi. Yapılan değerlendirilmesindeayna görüntüsü hayali dallanması ile sağ arkus aorta ve sol ligamentum arteriosumtespit edildi. Hastanın trakea ve özefagusunda değişen şiddetlerde bası mevcuttu.Opere edilen hastanın trakeal kompresyon sonucu gelişen trakeomalaziye bağlışikayetleri devam etti. Postoperatif 43. günde pnömoni ve sepsis nedeniyle hastakaybedildi. Bu hasta ile özellikle infant ve erken çocukluk döneminde acil servisekronik öksürük, stridor ve hırıltı gibi tekrarlayan solunum şikayetleri ve solunumarresti ile başvuran hastalarda vasküler ringin ayrıcı tanıda yer alması gerekliliğivurgulanmak istendi.

Respiratory Arrest in Infant Secondary to Vascular Ring;Mirror Image Branching with Right Aortic Arch and Left Ligamentum Arteriosum

Vascular ring is a group of abnormalities that may cause respiratory and feedingproblems with varying degrees of compression on the trachea and esophagusby the aortic arch and pulmonary artery. Cough, dyspnea, inspiratory stridor,dysphagia and respiratory failure are seen in these patients at varying intensities.The 15 days old male baby who had difficulty in breathing, had wheezing andcoughing was diagnosed with pneumonia and was hospitalized. The patientwas referred to us upon developing respiratory arrest. Mirror image branchingwith right arcus aorta and left ligamentum arteriosum was detected. Trachea andeosophagus of the patient were compressed at varying intensities. Symptoms ofthe patient related with tracheobronchomalacia which developed due to trachealcompression continued after operation. Patient died on the postoperative day 43after developing pneumonia and sepsis. With this patient emphasis was placed onthe necessity of vascular ring should be in the differential diagnosis in infant andearly childhood patients applying with recurrent respiratory symptoms such aswheezing, chronic cough, stridor and those applying with respiratory arrest to theemergency department.

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