Abstract
A 45-year-old male was scheduled to undergo septal myomectomy for hypertrophic obstructive cardiomyopathy. A double aortic arch was detected before the operation, but the patient was asymptomatic with no apparent compression of the airway caused by the vascular ring. Expiratory phase wheezing and dyspnea were noted immediately after postoperative extubation, and reintubation was performed. Bronchoscopy revealed obstruction of the trachea due to swelling of the membranous portion of the trachea in the direction of the tracheal lumen when coughing, and a diagnosis of tracheomalacia was made. Tracheostomy was performed and the patient was weaned from mechanical ventilation on postoperative day eleven and discharged from the ICU on postoperative day twelve. Tracheomalacia is thought to be caused by weakening of the supportive tissue of the airway, and the collapse of the airway in this case was thought to have been caused by surgical stress. It is concluded that either swelling around the vascular ring caused by surgical manipulation of the aorta compressed the trachea encircled by the vascular ring, or that the supportive power of the membranous portion of the trachea was reduced by the surgical procedure. This case reveals the possibility that tracheomalacia may occur postoperatively in adult patients with a double aortic arch even if they are asymptomatic preoperatively.
