Critical Tracheal Compression by a Double Aortic Arch in a Young Infant: A Case Report

Double aortic arch is a congenital vascular anomaly in which persistence of both fourth aortic arches creates a complete vascular ring around the trachea and esophagus.Severe airway compromise in early infancy may be life-threatening and can mimic intrinsic congenital airway disease.We report a six-week-old female infant with progressive noisy breathing, stridor, and respiratory distress, particularly during crying, who experienced three near-arrest episodes.Computed tomography angiography demonstrated a complete vascular ring formed by a double aortic arch with an atretic left arch and severe focal tracheal compression.The narrowest tracheal diameter measured 1.7 mm across a 5.1-mm segment at the T1/T2 level, with associated posterior esophageal compression.The right common carotid and right subclavian arteries arose from the right arch, whereas the left vertebral, left common carotid, and left subclavian arteries arose from the left arch.The infant underwent thoracotomy and release of the vascular ring.Respiratory distress and stridor improved markedly after surgery, and she was discharged breathing room air without stridor at rest and feeding well.The imaging findings and postoperative response supported extrinsic vascular compression rather than documented intrinsic congenital tracheal stenosis or a tracheal web.Recognition of the characteristic vascular anatomy is essential because double aortic arch, pulmonary artery sling, and intrinsic congenital tracheal stenosis have different anatomic substrates and surgical implications.