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withreportedlynormalexercisetolerance.148However,morecontemporary
singlecenterstudieshavedemonstratedpatencyofallleftpulmonaryartery
reimplantations,albeitwithvariableflowratesbasedonnuclearmedicine
studies.149Freedomfromairwayreinterventionhasbeenshowntobebetterwith
slidetracheoplastycomparedwithothersurgicaltechniques.150Specifically,
therewasahigherincidenceofpostoperativeinterventionforgranulationtissue
formationandforairwaystentimplantationinpatientsundergoingpatch
tracheoplastycomparedtoslidetracheoplasty.150
InnominateArteryCompressionSyndrome
Theindicationforsurgicalinterventiononinnominatearterycompression
syndromeincludessymptomaticpatientswithevidenceofcompressionofmore
than80%ofthetracheallumenbyfiberopticbronchoscopy(Fig.47.29).90When
surgeryisindicated,anaortopexycanbeperformedthrougharight
submammarythoracotomyortheinnominatearterycanbetransectedand
reimplantedmoreanteriorlyontheaorta.151
FIG.47.29 Computedtomogramreformattedintransverseaxialand
coronalplanesshowingthebrachiocephalicarteryarisingfromtheaortaon
theleftsideofmidlineandcoursingrightwardinfrontofthetrachea.The
tracheaismildlycompressed.Notethattheanteroposteriordimensionof
thethoraxisnarrowinthiscase.LCCA,Leftcommoncarotidartery;LSA,
leftsubclavianartery;RIA,rightinnominateartery.
VascularCompressionoftheAirway
WithoutVascularRingorSling
Asdiscussedearlierinthischapter,theshapeofthethoraciccageisanimportant
factorthatcontributestocompressionoftheairwayandesophagusinpatients
withananomalousaorticarchorpulmonaryarterialsling.Inaddition,abnormal