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Goussard P, Eber E, Venkatakrishna S, Janson J, Schubert P, Andronikou S. Bronchoscopy findings in children with congenital lung and lower airway abnormalities. Paediatr Respir Rev 2024; 49:43-61. [PMID: 37940462 DOI: 10.1016/j.prrv.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
Congenital lung and lower airway abnormalities are rare, but they are an important differential diagnosis in children with respiratory diseases, especially if the disease is recurrent or does not resolve. The factors determining the time of presentation of congenital airway pathologies include the severity of narrowing, association with other lesions and the presence or absence of congenital heart disease (CHD). Bronchoscopy is required in these cases to assess the airway early after birth or when intubation and ventilation are difficult or not possible. Many of these conditions have associated abnormalities that must be diagnosed early, as this determines surgical interventions. It may be necessary to combine imaging and bronchoscopy findings in these children to determine the correct diagnosis as well as in operative management. Endoscopic interventional procedures may be needed in many of these conditions, ranging from intubation to balloon dilatations and aortopexy. This review will describe the bronchoscopic findings in children with congenital lung and lower airway abnormalities, illustrate how bronchoscopy can be used for diagnosis and highlight the role of interventional bronchoscopy in the management of these conditions.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacques Janson
- Division of Cardiothoracic Surgery, Department of Surgical Sciences, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Xing F, Deng XM, Yang D. Goldenhar syndrome complicated with subglottic airway stenosis: a case report. BMC Anesthesiol 2023; 23:210. [PMID: 37328815 PMCID: PMC10273538 DOI: 10.1186/s12871-023-02179-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/14/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Goldenhar syndrome is a congenital disease that involves an absence or underdevelopment of structures that arise from the first and second pharyngeal arches and more or less severe extracranial anomalies. A variety of supraglottic malformations may be observed, including mandibular hypoplasia, mandibular asymmetry and micrognathia. Subglottic airway stenosis (SGS), which can cause difficulties in airway management during the perioperative period, is seldom emphasized in literature descriptions of Goldenhar syndrome, but can be clinically significant. CASE PRESENTATION An 18-year-old female with a history of Goldenhar syndrome presented for placement of a right mandibular distractor, right retroauricular dilator, and stage I transfer of a prefabricated expanded flap under general anesthesia. During tracheal intubation, the endotracheal tube (ETT) met resistance unexpectantly when attempting to pass through the glottis. Subsequently, we attempted the procedure with a smaller size ETT but again met resistance. With fiberoptic bronchoscope, we found that the whole segment of the trachea and bilateral bronchi were obvious narrow. Given the finding of unexpected severe airway stenosis and the associated risks with proceeding with the surgery, the operation was cancelled. We removed the ETT once the patient was fully awake. CONCLUSIONS Anesthesiologists should be aware of this clinical finding when evaluating the airway of a patient with Goldenhar syndrome. Coronal and sagittal measurements on computerized tomography (CT) and three-dimensional image reconstruction can be used to evaluate the degree of subglottic airway stenosis and measure the diameter of the trachea.
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Affiliation(s)
- Fei Xing
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, People's Republic of China
| | - Xiao Ming Deng
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, People's Republic of China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, People's Republic of China.
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Airway abnormalities associated with congenital heart disease. Pediatr Radiol 2022; 52:1849-1861. [PMID: 35778574 DOI: 10.1007/s00247-022-05429-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/07/2022] [Accepted: 06/08/2022] [Indexed: 10/17/2022]
Abstract
Airway abnormalities are important but sometimes overlooked problems in children with congenital heart disease. It is often difficult to separate symptoms related to cardiac disease from those associated with airway or lung disease. Some of the lesions are incidental while others cause significant symptoms and are important in overall functional outcome. Congenital and acquired as well as intrinsic and extrinsic lesions occur and can overlap. We review and illustrate these lesions here. Imaging plays a crucial role in diagnosing and assessing the severity of airway abnormalities and guiding medical and surgical management decisions.
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Moriuchi Y, Fuchigami T, Mizukoshi W, Morioka I. An Infant With Congenital Tracheal and Bronchial Stenosis Diagnosed by Chest Three-Dimensional Computed Tomography. Cureus 2022; 14:e24771. [PMID: 35676977 PMCID: PMC9167450 DOI: 10.7759/cureus.24771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
In this case report, we describe the case of an infant with repeated wheezing diagnosed relatively early with congenital tracheal and bronchial stenosis after evaluation by chest three-dimensional computed tomography (3D-CT). The patient was a six-month-old male infant with a one-month history of cough and wheezing. His symptoms worsened the day before admission, and he was admitted with pneumonia and wheezing. However, wheezing continued after treatment with intravenous steroids and inhalation of a short-acting β2-stimulant. 3D-CT of the chest revealed tracheal stenosis, right bronchial stenosis, and right tracheobronchial bronchus. The patient was finally diagnosed with congenital tracheal and bronchial stenosis via bronchoscopy. A virtual bronchoscopic navigation image of the tracheal lumen was created based on the CT images. Although virtual bronchoscopic navigation is more difficult for the dynamic evaluation and evaluation of mucosal lesions than bronchoscopy, it has the advantage of not directly invading the airway. Therefore, if a fixed stenotic lesion is suspected at a facility where bronchoscopy is difficult, evaluation using chest 3D-CT and virtual bronchoscopic navigation may be helpful for diagnosis. In conclusion, congenital tracheal/bronchial stenosis should be considered in patients with prolonged wheezing and recurrent airway infections, and evaluation by chest 3D-CT and virtual bronchoscopic navigation may be helpful for diagnosis.
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Atag E, Unal F, Yazan H, Girit S, Uyan ZS, Ergenekon AP, Yayla E, Merttürk E, Telhan L, Meral Ö, Kucuk HB, Gunduz M, Gokdemir Y, Erdem Eralp E, Kiyan G, Cakir E, Ersu R, Karakoc F, Oktem S. Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study. Pediatr Pulmonol 2021; 56:2925-2931. [PMID: 34236776 DOI: 10.1002/ppul.25566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/10/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Flexible bronchoscopy (FB) is frequently used for assessment and treatment of patients with respiratory diseases. Our aim was to investigate the contribution of FB to diagnosis and therapy in children admitted to the intensive care units (ICU) and to evaluate the safety of FB in this vulnerable population. METHODS Children less than 18 years of age who underwent FB in the five neonatal and pediatric ICUs in Istanbul between July 1st, 2015 and July 1st, 2020 were included to the study. Demographic and clinical data including bronchoscopy indications, findings, complications, and the contribution of bronchoscopy to the management were retrospectively reviewed. RESULTS One hundred and ninety-six patients were included to the study. The median age was 5 months (range 0.3-205 months). The most common indication of FB was extubation failure (38.3%), followed by suspected airway disease. Bronchoscopic assessments revealed at least one abnormality in 90.8% patients. The most common findings were airway malacia and the presence of excessive airway secretions (47.4% and 35.7%, respectively). Positive contribution of FB was identified in 87.2% of the patients. FB had greater than 1 positive contribution in 138 patients and 80.6% of the patients received a new diagnosis. Medical therapy was modified after the procedure in 39.8% and surgical interventions were pursued in 40% of the patients. Therapeutic lavage was achieved in 18.9%. There were no major complications. CONCLUSION Flexible bronchoscopy is a valuable diagnostic and therapeutic tool in neonatal and pediatric ICUs and is not associated with major complications.
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Affiliation(s)
- Emine Atag
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Fusun Unal
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Saniye Girit
- Division of Pediatric Pulmonology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Zeynep Seda Uyan
- Division of Pediatric Pulmonology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Almala Pınar Ergenekon
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Esra Yayla
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Edanur Merttürk
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Leyla Telhan
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Özge Meral
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Hanife Busra Kucuk
- Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Gunduz
- Division of Neonatalogy, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Faculty of Medicine Istanbul, Marmara University, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Faculty of Medicine Istanbul, Marmara University, Istanbul, Turkey
| | - Gursu Kiyan
- Department of Pediatric Surgery, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Refika Ersu
- Division of Pediatric Pulmonology, Faculty of Medicine Istanbul, Marmara University, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Sedat Oktem
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
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Ghezzi M, D’Auria E, Farolfi A, Calcaterra V, Zenga A, De Silvestri A, Pelizzo G, Zuccotti GV. Airway Malacia: Clinical Features and Surgical Related Issues, a Ten-Year Experience from a Tertiary Pediatric Hospital. CHILDREN-BASEL 2021; 8:children8070613. [PMID: 34356592 PMCID: PMC8307910 DOI: 10.3390/children8070613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022]
Abstract
Background: Few studies have been carried out with the aim of describing the clinical course and follow-up of patients with tracheomalacia. We aim to describe the symptoms at diagnosis and the post-treatment clinical course of patients affected by airway malacia. Methods: We retrospectively analyzed characteristics of pediatric patients with a diagnosis of airway malacia. Patients were classified into three groups: bronchomalacia (BM), tracheomalacia (TM) and tracheo-bronchomalacia (TBM). Demographic and clinical data, diagnostic work-up and surgical treatment were recorded. Results: 13/42 patients were affected by congenital syndromes (30.9%). Esophageal atresia with or without tracheal-esophageal fistula (EA/TEF) was detected in 7/42 patients (16.7%). Cardiovascular anomalies were found in 9/42 (21.4%) and idiopathic forms in 13/42 (30.9%). BM occurred in 7/42 (16.6%), TM in 23/42 (54.7%) and TBM in 12/42 (28.6%). At the diagnosis stage, a chronic cough was reported in 50% of cases with a higher prevalence in EA/TEF (p = 0.005). Surgery was performed in 16/42 (40%) of children. A chronic cough and acute respiratory failure were correlated to the need for surgery. During follow-up, there was no difference in persistence of symptoms between conservative vs surgical treatment (p = 0.47). Conclusion: the management of tracheomalacia remains a challenge for pediatricians. Clinical manifestations, such as a barking cough and acute respiratory failure may suggest the need for surgery. Follow-up is crucial, especially in those patients affected by comorbidities, so as to be able to manage effectively the possible persistence of symptoms, including those that may continue after surgical treatment.
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Affiliation(s)
- Michele Ghezzi
- Allergology and Pneumology Unit, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.); (A.F.); (A.Z.)
- Correspondence: ; Tel.: +039-02-6363-5797
| | - Enza D’Auria
- Allergology and Pneumology Unit, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.); (A.F.); (A.Z.)
| | - Andrea Farolfi
- Allergology and Pneumology Unit, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.); (A.F.); (A.Z.)
| | - Valeria Calcaterra
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (V.C.); (G.V.Z.)
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Alessandra Zenga
- Allergology and Pneumology Unit, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.); (A.F.); (A.Z.)
| | - Annalisa De Silvestri
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Gloria Pelizzo
- Department of Pediatric Surgery, V. Buzzi Children’s Hospital, 20154 Milan, Italy;
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, 20157 Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (V.C.); (G.V.Z.)
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, 20157 Milan, Italy
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Fujieda Y, Morita K, Fukuzawa H, Maeda K. Histological features of complete tracheal rings in congenital tracheal stenosis. Pediatr Surg Int 2021; 37:257-260. [PMID: 33388965 DOI: 10.1007/s00383-020-04803-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Congenital tracheal stenosis is a disease in which complete tracheal cartilage rings (CTCR) cause airway narrowing. Although tracheal cartilage malformation has been suggested as a cause of CTCR, no histological studies have been performed. Here, we report a comparison of the tissues from CTCR and normal tracheal cartilage. METHODS Thirty-one infants who underwent slide tracheoplasty at our institution from May 2016 to August 2019 were included. Tissues from ten autopsy cases without tracheal lesions were used as controls. The survey items were tracheal cartilage cell density, cartilage thickness, and chondrocyte findings. RESULTS The median cartilage cell density from cases was 23/125 × 125 µm2 and from controls was 23.5/125 × 125 µm2 (p = 0.90). The median cartilage thickness from cases was 689 µm and from controls was 840 µm (p = 0.11). Comparing the ventral and dorsal sides of the CTCR tissues, the cell density was significantly different (median ventral 23/125 × 125 µm2; median dorsal 19.5/125 × 125 µm2; p = 0.034). There were no significant findings in the chondrocytes of the CTCR tissues. CONCLUSION CTCR tissues did not differ in cartilage density and thickness from normal tracheal cartilage.
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Affiliation(s)
- Yuki Fujieda
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojima Minami-cho, Chuo-ku, Kobe, 650-0047, Japan.
| | - Keiichi Morita
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojima Minami-cho, Chuo-ku, Kobe, 650-0047, Japan
| | - Hiroaki Fukuzawa
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojima Minami-cho, Chuo-ku, Kobe, 650-0047, Japan
| | - Kosaku Maeda
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojima Minami-cho, Chuo-ku, Kobe, 650-0047, Japan
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Wu J, Mady LJ, Roy A, Aral AM, Lee B, Zheng F, Catalin T, Chun Y, Wagner WR, Yang K, Trejo Bittar HE, Chi D, Kumta PN. In-vivo efficacy of biodegradable ultrahigh ductility Mg-Li-Zn alloy tracheal stents for pediatric airway obstruction. Commun Biol 2020; 3:787. [PMID: 33339963 PMCID: PMC7749127 DOI: 10.1038/s42003-020-01400-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 10/09/2020] [Indexed: 11/24/2022] Open
Abstract
Pediatric laryngotracheal stenosis is a complex congenital or acquired airway injury that may manifest into a potentially life-threatening airway emergency condition. Depending on the severity of obstruction, treatment often requires a combination of endoscopic techniques, open surgical repair, intraluminal stenting, or tracheostomy. A balloon expandable biodegradable airway stent maintaining patency while safely degrading over time may address the complications and morbidity issues of existing treatments providing a less invasive and more effective management technique. Previous studies have focused on implementation of degradable polymeric scaffolds associated with potentially life-threatening pitfalls. The feasibility of an ultra-high ductility magnesium-alloy based biodegradable airway stents was demonstrated for the first time. The stents were highly corrosion resistant under in vitro flow environments, while safely degrading in vivo without affecting growth of the rabbit airway. The metallic matrix and degradation products were well tolerated by the airway tissue without exhibiting any noticeable local or systemic toxicity.
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Affiliation(s)
- Jingyao Wu
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Leila J Mady
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Abhijit Roy
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Ali Mübin Aral
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Boeun Lee
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Feng Zheng
- Institute of Metal Research, Chinese Academic of Sciences, Shenyang, 110016, China
| | - Toma Catalin
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, 15261, USA
- McGowan Institute of Regenerative Medicine, Pittsburgh, PA, 15261, USA
| | - Youngjae Chun
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- McGowan Institute of Regenerative Medicine, Pittsburgh, PA, 15261, USA
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - William R Wagner
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- McGowan Institute of Regenerative Medicine, Pittsburgh, PA, 15261, USA
- Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Ke Yang
- Institute of Metal Research, Chinese Academic of Sciences, Shenyang, 110016, China
| | - Humberto E Trejo Bittar
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - David Chi
- Department of Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, 15224, USA
| | - Prashant N Kumta
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
- McGowan Institute of Regenerative Medicine, Pittsburgh, PA, 15261, USA.
- Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
- Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
- Center for Complex Engineering Multi-functional Materials, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
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Ohno M, Fuchimoto Y, Higuchi M, Yamaoka T, Komura M, Umezawa A, Hsu HC, Enosawa S, Kuroda T. Long-term observation of airway reconstruction using decellularized tracheal allografts in micro-miniature pigs at growing stage. Regen Ther 2020; 15:64-69. [PMID: 33426203 PMCID: PMC7770338 DOI: 10.1016/j.reth.2020.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/15/2020] [Accepted: 04/25/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction Decellularized tissue exhibits cell matrix-like properties, along with reduced antigenicity. We explored the potential of decellularized allogeneic trachea to restore the upper respiratory tract, focusing on pediatric application. This study specifically aimed at long-term observation of tissue regeneration using a micro-miniature pig model. Methods Artificial defects (15 × 15 mm) in the subglottis and trachea of micro-miniature pigs were repaired by transplantation of either allogeneic decellularized or fresh (control) tracheal patches. Pigs were evaluated in situ, by bronchoscopy, every three months, and sacrificed for histological examination at six and twelve months after transplantation. Results No airway symptom was observed in any pig during the observation period. Bronchoscopy revealed the tracheal lumen to be restored by fresh grafts, showing an irregular surface with remarkable longitudinal compression; these changes were mild after restoration with decellularized grafts. Histologically, while fresh graft patches were denatured and replaced by calcified tissue, decellularized patches remained unchanged throughout the observation period. There were regeneration foci of cartilage adjacent to the grafts, and some foci joined the decellularized graft uniformly, suggesting the induction of tracheal reconstitution. Conclusion Allogeneic decellularized tracheal tissue could serve as a promising biomaterial for tracheal restoration, especially for pediatric patients at the growing stage.
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Affiliation(s)
- Michinobu Ohno
- Department of Pediatric Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama-shi, Saitama 336-8522, Japan.,Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Yasushi Fuchimoto
- Department of Pediatric Surgery, International University of Health and Welfare School of Medicine, 2600-1 Kitakanemaru, Ohtawara-shi, Tochigi 324-8501, Japan.,Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
| | - Masataka Higuchi
- Division of Pulmonology, Department of Medical Specialties, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Tetsuji Yamaoka
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Makoto Komura
- Department of Pediatric Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Huai-Che Hsu
- Division for Advanced Medical Sciences, National Center for Child Health and Development, 2-10-1 Okura,Setagaya-ku, Tokyo 157-8535, Japan
| | - Shin Enosawa
- Division for Advanced Medical Sciences, National Center for Child Health and Development, 2-10-1 Okura,Setagaya-ku, Tokyo 157-8535, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
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Mady LJ, Criado M, Park J, Baddour K, Aral AM, Roy A, Rigatti LH, Kumta PN, Chi DH. Subglottic Stenosis: Development of a Clinically Relevant Endoscopic Animal Model. Otolaryngol Head Neck Surg 2020; 162:905-913. [PMID: 32393104 DOI: 10.1177/0194599820921404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Develop a clinically relevant and reproducible endoscopic animal model for subglottic stenosis amenable to testing of minimally invasive therapeutic modalities. STUDY DESIGN Cohort study. SETTING Division of Laboratory Animals Research, University of Pittsburgh. SUBJECTS AND METHODS Subglottic stenosis was induced endoscopically via microsuspension laryngoscopy in 26 New Zealand white rabbits. A trimmed polypropylene brush connected to a novel electronic stenosis induction apparatus was used to create circumferential trauma to the subglottis. By using open source image analysis software, the cross-sectional areas of the stenotic and native airways were compared to calculate the percentage of stenosis and the Myer-Cotton classification grade. RESULTS Of the 26 rabbits, 24 (92%) exhibited stenosis after the first attempt. The mean percentage of airway stenosis was 57% (range, 34%-85%; SD, 15%). Five rabbits (19.2%) died on the day of stenosis induction from procedural complications. Of the 21 rabbits, 2 demonstrated no stenosis 7 days after initial injury and so underwent reinduction of airway injury, upon which they developed stenosis. Overall, 14 of the 21 rabbits (67%) exhibited moderate to severe stenosis (grade 2 or 3). CONCLUSION The stenosis induction apparatus reliably induced stenosis with a low mortality rate as compared with that of other methods in the literature. The device could be improved to generate a predetermined potentially reproducible grade of stenosis as desired by the operator. This method sets the stage for a clinically relevant and reproducible subglottic stenosis disease model that is amenable to testing of minimally invasive treatment modalities.
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Affiliation(s)
- Leila J Mady
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew Criado
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James Park
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Khalil Baddour
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ali Mubin Aral
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Abhijit Roy
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lora Heather Rigatti
- Division of Laboratory Animal Resources, University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Prashant N Kumta
- Departments of Bioengineering, Mechanical Engineering and Materials Science, and Chemical and Petroleum Engineering, Center for Complex Engineered Multifunctional Materials, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David H Chi
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Patino M, Chandrakantan A. Midgestational Fetal Procedures. CASE STUDIES IN PEDIATRIC ANESTHESIA 2019:197-201. [DOI: 10.1017/9781108668736.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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12
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Wallis C, Alexopoulou E, Antón-Pacheco JL, Bhatt JM, Bush A, Chang AB, Charatsi AM, Coleman C, Depiazzi J, Douros K, Eber E, Everard M, Kantar A, Masters IB, Midulla F, Nenna R, Roebuck D, Snijders D, Priftis K. ERS statement on tracheomalacia and bronchomalacia in children. Eur Respir J 2019; 54:13993003.00382-2019. [PMID: 31320455 DOI: 10.1183/13993003.00382-2019] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/16/2019] [Indexed: 01/20/2023]
Abstract
Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality either via a face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.
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Affiliation(s)
- Colin Wallis
- Respiratory Medicine Unit, Great Ormond Street Hospital for Children, London, UK
| | - Efthymia Alexopoulou
- 2nd Radiology Dept, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Juan L Antón-Pacheco
- Pediatric Airway Unit and Pediatric Surgery Division, Universidad Complutense de Madrid, Madrid, Spain
| | - Jayesh M Bhatt
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Andrew Bush
- Imperial College London and Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Anne B Chang
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | | | | | - Julie Depiazzi
- Physiotherapy Dept, Perth Children's Hospital, Perth, Australia
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Dept of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Mark Everard
- Division of Paediatrics, University of Western Australia, Perth Children's Hospital, Perth, Australia
| | - Ahmed Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
| | - Ian B Masters
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Fabio Midulla
- Dept of Paediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Raffaella Nenna
- Dept of Paediatrics, "Sapienza" University of Rome, Rome, Italy.,Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Derek Roebuck
- Interventional Radiology Dept, Great Ormond Street Hospital, London, UK
| | - Deborah Snijders
- Dipartimento Salute della Donna e del Bambino, Università degli Studi di Padova, Padova, Italy
| | - Kostas Priftis
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
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Kamran A, Jennings RW. Tracheomalacia and Tracheobronchomalacia in Pediatrics: An Overview of Evaluation, Medical Management, and Surgical Treatment. Front Pediatr 2019; 7:512. [PMID: 31921725 PMCID: PMC6922019 DOI: 10.3389/fped.2019.00512] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/26/2019] [Indexed: 01/13/2023] Open
Abstract
Tracheobronchomalacia (TBM) refers to airway collapse due to typically excessive posterior membrane intrusion and often associated with anterior cartilage compression. TBM occurs either in isolation or in association with other congenital or acquired conditions. Patients with TM typically present non-specific respiratory symptoms, ranging from noisy breathing with a typical barking cough to respiratory distress episodes to acute life-threatening events and recurrent and/or prolonged respiratory infections. There are no definitive standardized guidelines for the evaluation, diagnosis, and treatment of TBM; therefore, patients may be initially misdiagnosed and incorrectly treated. Although milder cases of TBM may become asymptomatic as the diameter of the airway enlarges with the child, in cases of severe TBM, more aggressive management is warranted. This article is an overview of the clinical presentation, evaluation, diagnosis, medical management, and surgical treatment options in pediatric tracheomalacia.
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Affiliation(s)
- Ali Kamran
- Department of General Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | - Russell W Jennings
- Department of General Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
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Bitoh Y, Okata Y, Tsugawa J, Miyauchi H, Aida Y, Tachibanaki Y, Nakai Y, Tomioka Y. Anterior-posterior cricoid split combined with silastic T-tube stenting for subglottic stenosis in children: a single surgeon's experience. Pediatr Surg Int 2018; 34:1041-1046. [PMID: 30097681 DOI: 10.1007/s00383-018-4328-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Treatment strategies and clinical outcomes of subglottic stenosis (SGS) in children are varied due to the degree and range of stenotic lesions. The optimal surgical procedure for SGS in children is still under debate. The aim of this study was to evaluate the clinical outcomes of our anterior-posterior cricoid (APC) split technique combined with long-term T-tube stenting for grade II or III SGS in children. METHODS A retrospective chart review of children with SGS between January 2011 and December 2016 was conducted. APC split was performed via open procedure under rigid bronchoscopy. After splitting, a silastic T-tube was inserted as a stent and removed 6 months postoperatively. RESULTS Seven children underwent APC split during the period. All children had undergone previous tracheostomy, and APC split was performed when the children were 3-9 years old without any intraoperative complications. Median duration of T-tube stenting was 11 months, and all children were decannulated successfully. There were T-tube-related complications, including two tube-tip granulation that required intervention and one accidental T-tube removal. CONCLUSION APC split is a technically simple and reproducible procedure, and it could be employed as an optimal procedure for SGS in children.
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Affiliation(s)
- Yuko Bitoh
- Division of Pediatric Surgery, Department of Surgery, Kobe University Hospital, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yuichi Okata
- Division of Pediatric Surgery, Department of Surgery, Kobe University Hospital, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Jiro Tsugawa
- Department of Pediatric Surgery, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Harunori Miyauchi
- Division of Pediatric Surgery, Department of Surgery, Kobe University Hospital, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yosuke Aida
- Division of Pediatric Surgery, Department of Surgery, Kobe University Hospital, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yumiko Tachibanaki
- Division of Pediatric Surgery, Department of Surgery, Kobe University Hospital, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yumiko Nakai
- Division of Pediatric Surgery, Department of Surgery, Kobe University Hospital, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuichiro Tomioka
- Division of Pediatric Surgery, Department of Surgery, Kobe University Hospital, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Okata Y, Hasegawa T, Bitoh Y, Maeda K. Bronchoscopic assessments and clinical outcomes in pediatric patients with tracheomalacia and bronchomalacia. Pediatr Surg Int 2018; 34:55-61. [PMID: 29124401 DOI: 10.1007/s00383-017-4209-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tracheomalacia and bronchomalacia (TM/BM) are one of the serious causes of airway obstruction in infants and children. This study reviewed our bronchoscopic assessments and clinical outcomes in pediatric patients with TM/BM, and investigated risk factors of surgical intervention for TM/BM. METHODS Fifty-seven consecutive patients who were diagnosed as TM/BM by bronchoscopy between 2009 and 2013 were reviewed retrospectively. They were divided into two groups according to the presence (group E, n = 26) or absence (group N, n = 31) of acute life-threatening events and extubation failure (ALTE/EF). The severity of TM/BM was evaluated by Oblateness Index which was obtained from bronchoscopic images. RESULTS Oblateness Index was significantly higher in Group E than in Group N. Patients in Group E underwent surgical intervention for TM/BM more frequently, and had significantly longer intubation period and hospital stay. Clinical symptoms of ALTE/EF, Oblateness Index ≥ 0.70, and multiple malacic lesions were significant risk factors indicating surgical events in patients with TM/BM. CONCLUSIONS Patients with TM/BM who had ALTE/EF had more severe malacic lesions indicating surgical intervention, and worse clinical outcomes. Oblateness Index is a simple and semi-quantitative index for bronchoscopic assessment of TM/BM, and can be one of the prognostic tools to predict clinical severity of pediatric TM/BM.
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Affiliation(s)
- Yuichi Okata
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Hyogo, 650-0047, Japan. .,Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Tomomi Hasegawa
- Department of Cardiovascular Surgery and Pediatric Critical Care Medicine, Kobe Children's Hospital, Kobe, Japan
| | - Yuko Bitoh
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Hyogo, 650-0047, Japan.,Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kosaku Maeda
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Hyogo, 650-0047, Japan
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