with reportedly normal exercise tolerance.148 However, more contemporary single center studies have demonstrated patency of all left pulmonary artery reimplantations, albeit with variable flow rates based on nuclear medicine studies.149 Freedom from airway reintervention has been shown to be better with slide tracheoplasty compared with other surgical techniques.150 Specifically, there was a higher incidence of postoperative intervention for granulation tissue formation and for airway stent implantation in patients undergoing patch tracheoplasty compared to slide tracheoplasty.150 Innominate Artery Compression Syndrome The indication for surgical intervention on innominate artery compression syndrome includes symptomatic patients with evidence of compression of more than 80% of the tracheal lumen by fiberoptic bronchoscopy (Fig 47.29).90 When surgery is indicated, an aortopexy can be performed through a right submammary thoracotomy or the innominate artery can be transected and reimplanted more anteriorly on the aorta.151 FIG 47.29 Computed tomogram reformatted in transverse axial and coronal planes showing the brachiocephalic artery arising from the aorta on the left side of midline and coursing rightward in front of the trachea The trachea is mildly compressed Note that the anteroposterior dimension of the thorax is narrow in this case LCCA, Left common carotid artery; LSA, left subclavian artery; RIA, right innominate artery Vascular Compression of the Airway Without Vascular Ring or Sling As discussed earlier in this chapter, the shape of the thoracic cage is an important factor that contributes to compression of the airway and esophagus in patients with an anomalous aortic arch or pulmonary arterial sling In addition, abnormal position or dilation of the otherwise normally formed vessels may cause compression of the airway or esophagus An elongated aortic arch may also compress the anterior wall of the trachea significantly, compromising the luminal patency.152 A classic example is the right aortic arch in congenitally corrected transposition (Fig 47.30) In this setting the aorta ascends on the left and takes a long transverse course in front of the trachea to connect to the descending aorta in the right posterior mediastinum Once the lungs are hyperinflated, they extend to the midline behind the sternum, pushing the mediastinal structures and heart backward, further compromising the tracheal and bronchial patency A posteriorly displaced ascending aorta may cause significant compression of the airways.71,153 The ascending aorta may directly compress the right side of the trachea In addition, the left main bronchus and, less commonly, the right main bronchus are compressed by the right pulmonary artery, which is also displaced backward by the posteriorly displaced ascending aorta FIG 47.30 In this patient with congenitally corrected transposition and a