Objective: Acyanotic congenital heart diseases may occasionally present with tracheobronchial obstruction. Increased pulmonary blood flow against a high-resistance pulmonary bed may create significant pulmonary artery dilation.
Methods: We report an unusual case of ventricular septal defect and right aortic arch coarctation, complicated with distal tracheal compression secondary to a pincer effect created by a right aortic arch and a massively dilated pulmonary artery.
Results: High index of suspicion is required to anticipate tracheobronchial compression in acyanotic congenital heart diseases.
Conclusion: Fiberoptic bronchoscopy is an invaluable tool to assess for tracheal compression relief following surgical repair and to identify tracheomalacia prior to extubation.