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figure 6-15 Tracheal obstruction by "hairpin" aortic arch: right aortic arch, right descending aorta, anomalous left subclavian artery originating from aortic diverticulum. A, Aortagram showing a high and narrow arch with a large Kommerell's diverticulum (arrow) from which the left subclavian artery originates. B, Computed tomography (CT) scan showing the trachea (arrow) compressed and displaced by the right aortic arch. Note the short distance between the sternum and vertebral bodies. C, Postoperative CT after aortic bypass, division of arch, and pexy of ascending arch by a Goretex sling (arrow) passed around an anterior rib. The tracheal lumen is widely opened.

left.41,42 Intraoperative bronchoscopy can monitor the degree of correction achieved by successive procedures, beginning with lesser ones, as in one of our patients cited above.

Compression of the trachea by a prominent innominate artery has been relieved by pexy of the artery and aortic arch to the sternum, leaving the trachea attached so that it is pulled forward and suspended.43,44 The validity of this diagnosis has been questioned, but there are instances of obstruction relieved by surgery.45 The artery has been divided and reimplanted more proximally on the aorta to successfully remove the point of tracheal compression and also the possibility of recurrence following suspension.46,47

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