Preoperative Computed Tomography Predictors of Airway Narrowing in Infants with Truncus Arteriosus
2Faculty of Medical and Health Sciences, Tel Aviv University, Israel
3Pediatric Cardiology Unit, Wolfson Medical Center, Israel
Purpose
Airway pathology is increasingly recognized as a relevant factor of morbidity in infants with congenital heart disease, most commonly due to external compression rather than intrinsic airway abnormalities. However, standardized methods for assessing airway compromise remain limited. Truncus arteriosus represents a unique anatomical model in which abnormal mediastinal geometry may predispose patients to significant bronchial narrowing. This study aimed to identify preoperative computed tomography (CT)-based anatomic and geometric features associated with bronchial narrowing in infants with truncus arteriosus and to describe postoperative respiratory outcomes.
Methods
This retrospective study included infants with truncus arteriosus who underwent preoperative cardiac CT. Airway and vascular dimensions were measured using standardized double-oblique techniques and normalized using CT-based z-scores. Mediastinal structures contributing to airway compression and overall geometric relationships were systematically evaluated. Descriptive statistics and nonparametric analyses were performed.
Results
Airway narrowing was common, with 18 of 20 infants (90%) demonstrating at least one bronchial segment with a z-score < −2. The left main bronchus was more severely affected than the right. Severe airway stenosis occurred in 3 infants (15%), clustering at markedly negative z-scores (−9 to −7). Pulmonary artery dilatation was frequent but not associated with airway narrowing severity. In contrast, severe airway compromise was characterized by multivector external compression involving the right pulmonary artery, descending aorta, and vertebral body. Infants with severe airway narrowing experienced prolonged postoperative respiratory morbidity, except in one case following pulmonary artery mobilization
Conclusion
Preoperative CT enables identification of mediastinal geometric configurations associated with severe airway narrowing in infants with truncus arteriosus. Clinically significant airway compromise appears to result primarily from complex mediastinal geometry and multivector external compression rather than vascular dilatation alone, with a particular predilection for the left bronchus