Respiratory stridor in children due to congenital abnormalities of the great vessels

Abstract

Introduction. The respiratory stridor is a clinical symptom of airway obstruction; depending on the location of the pathology we distinguish between inspiratory, expiratory and mixed stridor. Due to the coexistence of congenital airway pathology, stridor is frequently mixed. The most common cause of congenital stenosis of the airways is laryngomalacia, followed by paralysis of the vocal cords and congenital stenosis of the cricoid cartilage. A rare but important causes of the airways narrowing in children are anomalies of the great vessels compressing the trachea and bronchi from the outside. Aim. Aim of this study is to analyze the symptoms in children with respiratory stridor due to anomalies of the great vessels causing pressure on the respiratory tract from the outside. Material and methods. Retrospective study involved a group of 110 children hospitalized in the Pediatric Otolaryngology Department Medical University of Warsaw in 2011-2014 years due to congenital respiratory stridor. During the diagnostics procedures following tests were made: chest X-ray, US of the larynx, US of the brain, X-ray of the esophagus with contrast, echocardiogram and laryngotracheoscopy under general anastesia, chest angio-CT, neurological and cardiac consultation. Results. After analyzing of the cases, there has been found: laryngomalacia in 54, congenital paralysis of the vocal folds in 6, congenital stenosis of the cricoid cartilage in 5, hemangioma of the larynx in 5, laryngeal papilloma in 1, larynx cyst in 5, vascular ring in 31 cases. Identified as vascular rings include: double aortic arch – 5 cases, right aortic arch – 6 cases, anomalies of brachiocephalic trunk – 5 cases, left aortic arch with right lusorian artery – 14 cases, pulmonary sling – 1 case. The clinical symptoms presented by children with rings: respiratory stridor, exercise stridor, silent cry, sleep apnea, cyanosis, dysphagia, recurrent infections of the inferior respiratory tract. The age of children diagnosed with vascular ring ranged from 1 week to 11 years. Conclusions. 1. Congenital respiratory stridor always requires clinical interdisciplinary investigation. 2. Vascular anomalies are a major cause of congenital non-laryngeal respiratory stridor in children of all ages. 3. As a standard the endoscopy of the lower airways, not only the larynx but also trachea should be performed. 4. Lack of lower airways endoscopy in the diagnostic of congenital respiratory stridor can cause lack of recognition of vascular rings. 5. Deleted proper diagnosis of vascular anomalies can caused chronic changes in lower respiratory tract, weight and growth deficiency.