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Nguyen KT, Van Nguyen AT, Tran VQ, Nguyen YT, Le CT, Van Dang T, Jun TG, Nguyen TLT. Impact of preoperative respiratory distress on outcomes of slide tracheoplasty. Eur J Cardiothorac Surg 2024; 65:ezae227. [PMID: 38830041 DOI: 10.1093/ejcts/ezae227] [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: 01/10/2024] [Revised: 04/29/2024] [Accepted: 05/30/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVES Children with congenital tracheal stenosis born in the developing world face a high risk of mortality due to limited access to proper treatment. Patients who required preoperative respiratory support were suspected to have poor survival after slide tracheoplasty; however, this was not clearly demonstrated in the previous studies. This study aims to investigate the impact of preoperative respiratory conditions on outcomes of slide tracheoplasty. METHODS From 2016 to 2022, children who underwent slide tracheoplasty were retrospectively reviewed. Patients with respiratory distress requiring emergency operations (group A) were compared with patients in stable condition who were scheduled for surgery (group B). RESULTS Perioperative results revealed that group A (n = 43) had a longer bypass time (P < 0.001), operation time (P = 0.01), postoperative ventilation time (P < 0.001) and length of intensive care unit stay (P = 0.00125) than group B (n = 60). The early mortality rate was 7.8%, and the actuarial 5-year survival rate was 85.3%. The cumulative incidence test revealed that group A was highly significant for overall mortality [sudistribution (SHR) 4.5; 95% confidence interval (CI) 1.23-16.4; P = 0.023]. Risk factors for overall mortality were prolonged postoperative ventilation time (hazard ratio 3.86; 95% CI 1.20-12.48; P = 0.024), bronchial stenosis (hazard ratio 5.77; 95% CI 1.72-19.31; P = 0.004), and preoperative tracheal mucositis (hazard ratio 5.67; 95% CI 1.51-21.31; P = 0.01). Four patients needed reintervention during a follow-up of 28.4 months (interquartile range 15.3-47.3). CONCLUSIONS Preoperative respiratory distress negatively affected the outcomes of patients who required slide tracheoplasty. Therefore, early detection of congenital tracheal stenosis and aggressive slide tracheoplasty are crucial and obligatory to enhance long-term survival in this lethal congenital airway disease.
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Affiliation(s)
| | - Anh Thi Van Nguyen
- Department of Cardiology, Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Vinh Quang Tran
- Department of Cardiovascular Surgery, Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Yen Thi Nguyen
- Department of Pediatrics, Hanoi Medical University, Hanoi, Vietnam
| | - Chuong Thanh Le
- Department of Pneumology, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Thuc Van Dang
- Department of Intensive Care Unit, Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Korea
| | - Truong Ly Thinh Nguyen
- Department of Cardiovascular Surgery, Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam
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Hu J, Wang H, Du X, Zhu L, Wang S, Zhang H, Xu Z, Chen H. Morphologic classification of tracheobronchial arborization in children with congenital tracheobronchial stenosis and the associated cardiovascular defects. Front Pediatr 2023; 11:1123237. [PMID: 37287629 PMCID: PMC10242125 DOI: 10.3389/fped.2023.1123237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/28/2023] [Indexed: 06/09/2023] Open
Abstract
Background We sought to classify patients with congenital tracheal stenosis (CTS) according to tracheobronchial morphology and determine anatomic features associated with tracheobronchial anomalies (TBAs) and concurrent cardiovascular defects (CVDs). Methods We enrolled 254 patients who underwent tracheoplasty between November 1, 2009 and December 30, 2018. The anatomic features of the tracheobronchial tree and cardiovascular system were abstracted from bronchoscopy, echocardiography, computerized tomography, and operative reports. Results Four types of tracheobronchial morphology were identified: Type-1, which included normal tracheobronchial arborization (Type-1A, n = 29) and tracheal bronchus (Type-1B, n = 22); Type-2 (tracheal trifurcation; n = 49), and Type-3 (typical bridging bronchus; n = 47). Type-4 (bronchus with an untypical bridging pattern) was divided into Type-4A (involving bronchial diverticulum; n = 52) and Type-4B (absent bronchus; n = 55). Carinal compression and tracheomalacia were significantly more frequent in Type-4 patients than in the other patients (P < 0.01). CVDs were common in patients with CTS, especially in patients with Type-3 and Type-4 (P < 0.01). Persistent left superior vena cava was most common among patients with Type-3 (P < 0.01), and pulmonary artery sling was most frequent among those with Type-4 (P < 0.01). Outflow tract defects were most likely to occur in Type-1B. Early mortality was detected in 12.2% of all patients, and young age (P = 0.02), operation in the early era (P < 0.01), and bronchial stenosis (P = 0.03) were proven to be risk factors. Conclusions We demonstrated a useful morphological classification for CTS. Bridging bronchus was most closely linked with vascular anomalies, while tracheal bronchus was frequently associated with outflow tract defects. These results may provide a clue to CTS pathogenesis.
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Affiliation(s)
- Jie Hu
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Wang
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinwei Du
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Limin Zhu
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shunmin Wang
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiwei Xu
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Chen
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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3
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Tracheal reconstruction surgery for congenital tracheal stenosis. Pediatr Surg Int 2023; 39:123. [PMID: 36787049 DOI: 10.1007/s00383-023-05418-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Congenital tracheal stenosis is a rare but dangerous disease. Reconstructive tracheal surgery is a life-saving treatment but also a challenging procedure. This study aims to evaluate the outcomes of tracheal reconstruction surgery. METHODS A prospective cohort study was conducted with all the records of congenital tracheal stenosis which had been managed by tracheal reconstruction surgery at Children's Hospital 2 Ho Chi Minh City from August 2013 to August 2022. RESULTS Sixty-seven cases, who underwent slide tracheoplasty, were included in our study. Mean age was 7.6 months (25 days - 8 years). Common congenital-associated lesion was left pulmonary artery sling, accounting for 65.7% of cases. Bronchial stenosis was found in 22.4% patients. Emergency surgery was performed in eight cases. The survival rate in this review was 86.6%. Nine patients died in which four of nine cases (44.4%) were emergency surgery. The recurrent stenosis rate was 8.9%, only two cases needed reoperation in which one died and one recovered uneventfully. The outcomes of surgery were good in 53 cases (79.1%). CONCLUSION Tracheal reconstruction surgery with slide tracheoplasty technique is safe and versatile technique which is feasible in every case of congenital tracheal stenosis. Mortality was associated with severe cases which required emergency surgery.
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Naik N, Bhatia A, Mathew JL, Sodhi KS, Saxena AK. Tracheal trifurcation: An uncommon anomalous tracheal arborization. Pediatr Pulmonol 2023; 58:356-357. [PMID: 36192828 DOI: 10.1002/ppul.26177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Niveditha Naik
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Joseph L Mathew
- Department of Pediatric Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit S Sodhi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay K Saxena
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Morais CG, Baptista C, Grilo M, Moreira A, Ribeiro A. Challenging Diagnosis of a Congenital Tracheal Malformation: Considerations From an Intensive Care Perspective. Cureus 2023; 15:e34404. [PMID: 36874726 PMCID: PMC9978948 DOI: 10.7759/cureus.34404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
Congenital tracheal stenosis is a rare airway malformation. A high index of suspicion is fundamental. The authors report a case of congenital tracheal stenosis in a 13-month-old male infant, with a challenging diagnosis from the intensive care perspective. At birth, the patient presented an anorectal malformation with a recto-urethral fistula so a colostomy with mucous fistula was performed in the neonatal period. At the age of seven months, he was admitted due to a respiratory infection, treated with steroids and bronchodilators, and discharged after three days without any complications. He underwent complete repair of tetralogy of Fallot when he was 11 months old, which was performed without any reported perioperative complications. However, at the age of 13 months, due to another respiratory infection, he presented more severe symptoms and required admission to the pediatric intensive care unit (PICU) for invasive mechanical ventilation. He was intubated on the first attempt. While monitoring the difference between peak inspiratory and plateau pressures, we observed a sustained elevated difference between pressures suggestive of increased airway resistance, thus raising the possibility of an anatomical obstruction. Laryngotracheoscopy confirmed distal tracheal stenosis (grade II) with four complete tracheal rings. In our case, the absences of perioperative challenges or complications in previous respiratory infections were not suggestive of a tracheal malformation. Furthermore, no difficulties were encountered during intubation due to the distal location of the tracheal stenosis. A careful appreciation of respiratory mechanics on the ventilator at rest and during tracheal aspirations was essential to suspect an anatomical defect.
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Affiliation(s)
- Catarina G Morais
- Pediatrics, Centro Hospitalar e Universitário de São João, Porto, PRT
| | - Carolina Baptista
- Pediatric Intensive Care Unit, Centro Hospitalar e Universitário de São João, Porto, PRT
| | - Marta Grilo
- Pediatric Intensive Care Unit, Centro Hospitalar e Universitário de São João, Porto, PRT
| | - Amélia Moreira
- Pediatric Intensive Care Unit, Centro Hospitalar e Universitário de São João, Porto, PRT
| | - Augusto Ribeiro
- Pediatric Intensive Care Unit, Centro Hospitalar e Universitário de São João, Porto, PRT
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Lui NS, Holsinger FC, Ma MR, Janus JR, Balakrishnan K. Single-port robotic transcervical long-segment thoracic tracheal reconstruction: Cadaveric proof-of-concept study. JTCVS Tech 2022; 16:231-236. [PMID: 36510525 PMCID: PMC9735391 DOI: 10.1016/j.xjtc.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/13/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022] Open
Abstract
Objective Slide tracheoplasty is the standard technique to repair congenital long-segment tracheal stenosis. This operation most commonly requires median sternotomy, which has drawbacks in young children. We hypothesized that a transcervical approach without sternotomy would be feasible if done with a single-port robotic system. Methods This proof-of concept study was performed in 2 small adult cadavers using a single-port robotic surgical system via a small neck incision. Relevant information, including operative time and details of operative technique, were recorded. Results Long-segment slide tracheoplasty was completed successfully in 2 cadavers using a small neck incision and a single-port robotic surgical system. Strengths and pitfalls of the technique were identified, including technical refinements from the first attempt to the second. Operative time for robotic mobilization, incision, and anastomosis of the trachea was comparable to standard open approaches. Conclusions Small-incision transcervical slide tracheoplasty, assisted by a single-port surgical robotic system, is feasible in a human cadaver. More work is needed to determine safety and applicability in live patients, particularly in children.
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Affiliation(s)
- Natalie S. Lui
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | - F. Christopher Holsinger
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | - Michael R. Ma
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, Calif,Aerodigestive and Airway Reconstruction Program, Lucile Packard Children's Hospital, Palo Alto, Calif
| | - Jeffrey R. Janus
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Jacksonville, Fla
| | - Karthik Balakrishnan
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, Calif,Aerodigestive and Airway Reconstruction Program, Lucile Packard Children's Hospital, Palo Alto, Calif,Address for reprints: Karthik Balakrishnan, MD, MPH, FAAP, FACS, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, 2nd Floor, Palo Alto, CA 94305.
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Johansen M, Veyckemans F, Engelhardt T. Congenital anomalies of the large intrathoracic airways. Paediatr Anaesth 2022; 32:126-137. [PMID: 34797930 DOI: 10.1111/pan.14339] [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: 09/21/2021] [Revised: 11/03/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Abstract
Congenital lung lesions are numerous but rare in individual clinical practice. They do require close multidisciplinary collaboration between health care professionals. This educational review will focus on the pathophysiology, clinical manifestations, surgical approaches, and anesthetic management of congenital anomalies of the large intrathoracic airways: congenital tracheal stenosis, tracheal agenesis, tracheal diverticulum, bronchial anomalies (tracheal, esophageal, or bridging bronchus), congenital lung malformations, lung sequestrations and Scimitar syndrome, lobar emphysema, Williams-Campbell syndrome, and pleuropulmonary blastoma. In addition, this review will illustrate common pitfalls and challenges related to the anesthesia management with emphasis on ventilation and correct endotracheal tube positioning.
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Affiliation(s)
- Mathias Johansen
- Department of Paediatric Anaesthesiology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Francis Veyckemans
- Clinique d'Anesthésie Pédiatrique, Hôpital Jeanne de Flandre, CHU de Lille, Lille, France
| | - Thomas Engelhardt
- Department of Paediatric Anaesthesiology, Montreal Children's Hospital, Montreal, Quebec, Canada
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Aoki K, Kurosawa H, Seino Y, Morita K, Matsuhisa H, Oshima Y. Closed-PICU perioperative management of congenital tracheal stenosis. Pediatr Int 2022; 64:e15085. [PMID: 34865290 DOI: 10.1111/ped.15085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/08/2021] [Accepted: 12/03/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Perioperative management of congenital tracheal stenosis (CTS) is challenging. In the present study, compared the effect of closed-pediatric intensive care unit (PICU) perioperative management by pediatric intensivists and open-PICU management by surgeons. Outcomes in terms of ventilator-free days (VFD) and length of postoperative PICU stay in children with CTS were evaluated. METHODS This retrospective cohort study was conducted in a PICU in Japan. Children with CTS who underwent slide tracheoplasty were grouped according to whether they were perioperatively managed in an open (January 2015 to April 2016) or a closed (May 2016 to August 2019) PICU. Data were extracted from patients' medical records. RESULTS In total, 13 and 38 patients were included in the open- and closed-PICU groups, respectively. Compared to the open-PICU group, the closed-PICU group had shorter duration of muscle relaxant administration (median 4 vs 5 days; P < 0.001), earlier enteral nutrition (34/38 [90%] vs 1/13 [8%]; P < 0.001), more 28-day VFD (median 21 vs 20 days; P = 0.04), and shorter duration of postoperative PICU stay (median 16 vs 36 days; P = 0.002), but mortality did not differ significantly between the two groups (0/38 [0%] vs 1/13 [8%]; P = 0.25). CONCLUSIONS Closed-PICU perioperative management with pediatric intensivists' participation significantly increased 28-day VFD and reduced the length of postoperative PICU stay in patients with congenital tracheal stenosis.
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Affiliation(s)
- Kazunori Aoki
- Division of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Hiroshi Kurosawa
- Division of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Yusuke Seino
- Division of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Keiichi Morita
- Division of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Hironori Matsuhisa
- Division of Cardiovascular Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Yoshihiro Oshima
- Division of Cardiovascular Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
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Wen W, Du X, Zhu L, Wang S, Xu Z, Lu Z. Surgical management of long-segment congenital tracheal stenosis with tracheobronchial malacia. Eur J Cardiothorac Surg 2021; 61:1001-1010. [PMID: 34940823 DOI: 10.1093/ejcts/ezab551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/17/2021] [Accepted: 11/22/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Slide tracheoplasty has become the mainstream treatment for long-segment congenital tracheal stenosis (LSCTS). However, technical improvements are still needed to improve the clinical outcomes of patients exhibiting LSCTS with tracheobronchial malacia. METHODS LSCTS patients who underwent tracheoplasty from January 2010 to December 2020 were reviewed. According to the time of surgical technique modifications for reconstructing a supportive carina, the patients were divided into 2 groups: group A (2010-2018) and group B (2019-2020). We identified a well-balanced cohort matched by propensity score to evaluate the differences in surgical outcomes between the 2 groups. RESULTS There were no significant differences between group A and group B in any of the 8 characteristics before and after propensity score matching. In the propensity score-matched cohort, the number of patients who accepted anterior carina tracheopexy (75/77 vs 4/77, P < 0.001) and in situ pericardium insertion (75/77 vs 14/77, P < 0.001) in group B was significantly greater than that in group A. The mechanical ventilation time [48.3 (interquartile range: 29.6, 116.3) h vs 73.3 (interquartile range: 47.9, 111.6) h, P = 0.009] and cumulative mortality (P = 0.023) were significantly lower in Group B than Group A. CONCLUSIONS Reconstructing a supportive, stable carina of the neotrachea and tracheobronchopexy are helpful to improve the outcomes of slide tracheoplasty.
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Affiliation(s)
- Wanyu Wen
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xinwei Du
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Limin Zhu
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shunmin Wang
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhiwei Xu
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhaohui Lu
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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10
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Santangelo TP, Ottavianelli A, Curione D, Casazza I, Viglietti D, Agati S, Galletti L, Tomà P, Secinaro A. Tracheal trifurcation: new cases and review of the literature. Pediatr Radiol 2021; 51:1848-1855. [PMID: 34050380 DOI: 10.1007/s00247-021-05075-y] [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: 09/17/2020] [Revised: 01/07/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tracheal trifurcation is an uncommon and often unknown type of anomalous tracheobronchial arborization, characterized by three main bronchi originating at the level of the carina. Diagnosis is important due to its clinical implications. OBJECTIVE To highlight the anatomical, clinical and diagnostic aspects of tracheal trifurcation by reporting our experience and reviewing the literature. MATERIALS AND METHODS We retrospectively evaluated pediatric patients referred to our institution from January 2018 to May 2020 with a diagnosis of tracheal trifurcation. All patients underwent chest radiographs, computed tomography (CT) (with/without dynamic airway scanning) and bronchoscopy. Clinical and anatomical data were collected. RESULTS Three patients with tracheal trifurcation were identified (1 female, median age: 7.6±0.4 months). All had associated anomalies: two had tetralogy of Fallot, one with esophageal atresia/tracheoesophageal fistula and one with an atrioventricular septal defect, and the other had skeletal ciliopathy. Chest radiographs were not diagnostic for tracheal trifurcation. Bronchoscopy could not fully evaluate the trachea and main bronchi in two cases. CT detected tracheal trifurcation in all of the patients and also demonstrated other lung parenchymal and congenital anomalies. Two of the three main bronchi were directed to the right lung in all cases. Ostial stenosis of either the central (two patients) or right upper bronchus (one patient) was present. No signs of tracheobronchomalacia were found. CONCLUSION Tracheal trifurcation is rare and often associated with additional disorders, such as other tracheobronchial anomalies, cardiovascular defects or esophageal malformations, responsible for clinical manifestations and earlier detection. Bronchoscopy is often used for diagnosis, but is invasive and may be incomplete or inconclusive, while CT allows for a noninvasive and correct diagnosis, while also highlighting additional findings in the thorax.
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Affiliation(s)
- Teresa Pia Santangelo
- Advanced Cardiovascular Imaging Unit-Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, RM, Italy
| | - Alessandra Ottavianelli
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, RM, Italy.
| | - Davide Curione
- Advanced Cardiovascular Imaging Unit-Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, RM, Italy
| | - Ines Casazza
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, RM, Italy
| | - Daniela Viglietti
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, RM, Italy
| | - Salvatore Agati
- Mediterranean Pediatric Cardiac Surgery Unit, San Vincenzo Hospital, Taormina, ME, Italy
| | - Lorenzo Galletti
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, RM, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, RM, Italy
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit-Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, RM, Italy
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Abstract
Congenital airway anomalies (CAA) include a variety of conditions that cause respiratory distress in neonates and infants. These malformations occur at various anatomic levels and manifest in a wide spectrum of airway symptoms, with presentation significantly influenced by the level at which obstruction occurs as well as by the severity of obstruction. The prevalence of congenital airway malformations has been estimated to range between 0.2 and 1 in 10,000 live births. The most frequent CAA are laryngomalacia, bilateral vocal cord paralysis, subglottic stenosis, laryngeal webs, subglottic hemangioma, tracheomalacia, congenital tracheal stenosis, laryngotracheal cleft, and tracheal agenesis.
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Affiliation(s)
- Patricio Varela
- Program Director Pediatric Airway Unit, Mackenna Children's Hospital, University of Chile, Clínica Las Condes Medical Center. Santiago, Chile.
| | - Claudia Schweiger
- Pediatric ENT, Hospital De Clinicas de Porto Alegre, Porto Alegre, Brazil
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12
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Beeman A, Ramaswamy M, Chippington S, Wallis C, Hayden M, Hewitt R, Muthialu N. Risk Stratification of Slide Tracheoplasty for Pediatric Airway Stenosis. Ann Thorac Surg 2021; 113:1299-1306. [PMID: 33864756 DOI: 10.1016/j.athoracsur.2021.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/01/2021] [Accepted: 04/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Slide tracheoplasty (STP) is the procedure of choice for treatment of long segmental congenital tracheal stenosis (LSCTS). Few studies predict factors leading to reintervention or mortality after STP. We analyzed a pediatric population to identify such factors and compared the outcome between 2 eras (1995-2012 and 2013-2017). METHODS We analyzed 150 consecutive children who underwent STP from February 1995 to December 2017 in our hospital. RESULTS Median age and weight were 6.9 months and 6.1 kg. Average tracheal diameter of LSCTS was 2.3 mm. Tracheal stenosis extended into bronchus in 36 patients and distal malacia in 38. Median follow-up was 67 months; mortality was 12.7%. Balloon dilatation was required in 81 patients (54%), stents in 29 (19%), and reoperation in 4 (3%). The presence of malacia, preoperative extracorporeal membrane oxygenation, congenital anomalies, and single lung anatomy increased the risk for reintervention. Cox regression analysis revealed preoperative ventilation to be an independent factor predicting reintervention and single lung tracheal anatomy for mortality. In the current era (after 2013), survival improved from 88% to 97% and stent requirement was reduced from 25% to 11%. CONCLUSIONS Slide tracheoplasty can be applied to various airway configurations seen in LSCTS. The requirement for reintervention such as balloon dilatation and stenting is high in the group requiring preoperative ventilation. Mortality is highest in the single lung anatomy group. Centralization of care allowed us to develop the multidisciplinary team expertise to manage this and other rare airway conditions with acceptable outcomes.
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Affiliation(s)
- Arun Beeman
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Madhavan Ramaswamy
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Samantha Chippington
- Department of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Collin Wallis
- Department of Respiratory Medicine, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Mark Hayden
- Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Richard Hewitt
- ENT, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom.
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Nimeri N, Ali H, Mahmoud N. Lethal severe congenital tracheal stenosis with tracheal ring complicating respiratory distress syndrome in an extremely premature infant: first reported case in Qatar with a literature review. BMJ Case Rep 2020; 13:13/12/e236107. [PMID: 33310828 PMCID: PMC7735117 DOI: 10.1136/bcr-2020-236107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In the context of prematurity, lethal congenital airways malforamtion can be masked by the symptoms of respiratory distress syndrome. A high index of suspicion is required. We present the case of a 28-week preterm infant, with atypical protracted respiratory insufficiency despite the escalation of mechanical ventilation. The possibility of airway obstruction was considered in view of severe chest retraction while on the mechanical ventilator. It was also difficult to pass suction catheters beyond a certain depth in the trachea; however, intubation of the upper trachea was accomplished twice without difficulty. Flexible bronchoscopy revealed complete tracheal ring with severe tracheal stenosis; there was no evidence of tracheo-oesophageal fistula. Due to advanced multi-organ dysfunction at diagnosis, a decision was made with the family to re-orientate from intensive care to compassionate care. Ethical considerations in similar cases should incorporate the improved outcomes of prematurity and recent advances in tracheal reconstruction.
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Affiliation(s)
- Nuha Nimeri
- Department of Paediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Haytham Ali
- Department of Pediatric, Sidra Medical and Research Center, Doha, Qatar
| | - Nazla Mahmoud
- Department of Paediatrics, Hamad Medical Corporation, Doha, Qatar
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14
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Congenital Anomalies of the Tracheobronchial Tree: A Meta-Analysis and Clinical Considerations. Ann Thorac Surg 2020; 112:315-325. [PMID: 33159867 DOI: 10.1016/j.athoracsur.2020.08.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/29/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of this study was to determine the prevalence and anatomic features of major tracheobronchial anomalies. METHODS Major electronic databases were systematically searched to identify eligible studies. Data were extracted and pooled into a meta-analysis. The primary outcome was the prevalence of major tracheobronchial anomalies, specifically tracheal bronchus (TB) and accessory cardiac bronchus (ACB). Secondary outcomes included the origin and types of TB and ACB. RESULTS A total of 27 studies (n = 119,695 patients) were included. A TB was present in 0.99% (95% confidence interval, 0.67 to 1.37) of patients, and an ACB was present in 0.14% (95% confidence interval, 0.09 to 0.20). The overall prevalence of TB was higher in imaging than in operative studies (1.81% vs 0.82%). It was also higher in pediatric (2.55%) than in adult studies (0.50%). Patients with other congenital anomalies were 15 times more likely to have a TB (odds ratio 14.89; 95% confidence interval, 7.09 to 31.22). The most common origin of TBs was from the trachea (81.42%), primarily from the right side (96.43%). The most common origin of ACBs was from the intermediate bronchus (74.32%). The ACBs terminated as blind-ending diverticulum in two thirds of cases. CONCLUSIONS Major tracheobronchial anomalies are present in approximately 1% of the population, although the prevalence is higher among pediatric patients and patients with accompanying congenital anomalies. Although rare, major tracheobronchial anomalies can be associated with significant respiratory morbidities and present challenges during airway management in surgical and critical care patients. Establishing a preoperative diagnosis of these variations is essential for planning and implementing an appropriate airway management strategy to minimize attendant complications.
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15
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Liu R, Rui L, Li S, Zhang B, Zhang H, Lin Y, Li H. Absorbable Microplate Externally Suspending Bronchomalacia in Congenital Heart Disease Infant. Pediatr Cardiol 2020; 41:1092-1098. [PMID: 32382764 DOI: 10.1007/s00246-020-02358-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
To evaluate the feasibility and efficacy of external suspension with absorbable poly-l-lactic acid material shaping microplates for infants with severe bronchomalacia and congenital heart disease. From November 2017 to January 2019, 11 continual patients with severe bronchomalacia and congenital heart disease underwent bronchial membrane external suspension together with cardiovascular surgery. An absorbable plate made with poly-l-lactic acid material was used as the shaping fixation material in all patients. Data included the details of the operation, and clinical results were collected. The mean age was 1.2 ± 1.0 years, and the mean weight was 7.7 ± 2.9 kg. The patients with cardiac malformations were operated on under low-temperature cardiopulmonary bypass (CPB) through median sternotomy. There were no in-hospital deaths. The CPB time, mechanical ventilation time, and length of intensive care unit stay were 123.9 ± 36.9 min, 20.7 ± 19.4 h, and 71.6 ± 54.9 h, respectively. Two patients underwent surgery through a left posterolateral incision without CPB. One was a double aortic arch repair, and the other was only bronchial membrane external suspension with prior IAA repair. No patients needed ECMO support. The mean follow-up time was 12.1 ± 5.6 months, and no patients were lost to follow-up. No cases of late death were noted, and no patients needed reoperation. According to the CT scans, no patients had bronchial restenosis. External bronchial membrane suspension with an absorbable poly-l-lactic acid material shaping plate, which had better histocompatibility, for infants with severe bronchomalacia and congenital heart disease was a safe and feasible procedure.
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Affiliation(s)
- Rui Liu
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Lu Rui
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Shoujun Li
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Benqing Zhang
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Heng Zhang
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Ye Lin
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Hanmei Li
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
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16
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Intermediate-Term Outcomes of Slide Tracheoplasty in Pediatric Patients With Ring-Sling Complex. Ann Thorac Surg 2020; 109:820-827. [DOI: 10.1016/j.athoracsur.2019.06.093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022]
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17
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Song X, Lu Z, Zhu L, Du X, Wang S, Xu Z. Morphologic Analysis of Congenital Heart Disease With Anomalous Tracheobronchial Arborization. Ann Thorac Surg 2020; 110:1387-1395. [PMID: 32114043 DOI: 10.1016/j.athoracsur.2020.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/28/2019] [Accepted: 01/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study investigated the morphologic characteristics of congenital heart disease (CHD) combined with anomalous tracheobronchial arborization (ATBA) to provide new considerations for surgically treating congenital tracheal stenosis. METHODS A retrospective review of surgical experience with ATBA was conducted of 147 patients. The proportion of patients with ATBA combined with tracheal stenosis was determined. Four ATBA types were identified: type A, tracheal bronchus (n = 58); type B, bronchial trifurcation (n = 46); type C, bridging bronchus (n = 38); and type D, tracheal bronchus combined with bronchial trifurcation (n = 5). The rate of tracheoplasty for each type was determined. We measured the carina/pseudocarina angle and assessed the distribution of CHD, especially pulmonary artery sling. RESULTS The tracheal diameter of 14 patients (24.1%) with type A and 5 patients (10.9%) with type B was normal. There were 128 patients with tracheal stenosis and complete tracheal rings; of them, 113 patients received tracheoplasty. The tracheoplasty rate was higher for type C than type A (100% vs 62.1%, P < .001). The carina/pseudocarina angle was significantly reduced postoperatively (P < .001). The repair in 78 patients (60.9%) was combined with a pulmonary artery sling. A pulmonary azygos lobe was found in 10 patients (6.8%) and was resected. CONCLUSIONS ATBA is common in patients with congenital tracheal stenosis and may be associated with abnormal embryonic development. The new classification of ATBA has clinical significance in treating patients with congenital tracheal stenosis. The poor tracheal development cannot be explained merely with vascular compression. Tracheoplasty is currently the optimal option for every type.
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Affiliation(s)
- Xiaoqi Song
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhaohui Lu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Limin Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xinwei Du
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shunmin Wang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Zhiwei Xu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
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18
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Yamoto M, Fukumoto K, Urushihara N. Tracheoplasty for Congenital Tracheal Stenosis with Bilateral Tracheal Bronchus. Ann Thorac Cardiovasc Surg 2020; 28:159-162. [PMID: 31996506 PMCID: PMC9081466 DOI: 10.5761/atcs.cr.19-00198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Congenital tracheal stenosis (CTS) with a bilateral tracheal bronchus (TB) has not been reported as a subtype of CTS. A novel technique to manage CTS in patients with a bilateral TB is described. Case Report: An infant with tetralogy of Fallot underwent repair of cardiac anomaly at age 1 month. He experienced numerous cyanosis and episodes of transient respiratory arrest. Chest computed tomography (CT) demonstrated an aberrant bilateral upper lobe bronchus arising directly from the trachea and a stenotic trachea connecting the pseudo- carina to the true carina between the common right lower and left lower bronchus. On bronchoscopy, the diameter of the lumen of the narrowed segment was estimated to be less than 2 mm. Tracheal reconstruction was undertaken when he was 2 years of age. The surgical technique using a modified slide tracheoplasty for the correction of this anomaly are described. After surgery, the patient was extubated and has had no respiratory symptoms. Discussion and Conclusion: The patient had unique anatomic considerations that made reconstruction challenging. Our technique of covering a stenotic section by normal trachea is a modification of the slide tracheoplasty technique and is useful for CTS with a unilateral and a bilateral TB.
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Affiliation(s)
- Masaya Yamoto
- Departments of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Shizuoka, Japan
| | - Koji Fukumoto
- Departments of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Shizuoka, Japan
| | - Naoto Urushihara
- Departments of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Shizuoka, Japan
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19
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Elliott MJ, Butler CR, Varanou-Jenkins A, Partington L, Carvalho C, Samuel E, Crowley C, Lange P, Hamilton NJ, Hynds RE, Ansari T, Sibbons P, Fierens A, McLaren C, Roebuck D, Wallis C, Muthialu N, Hewitt R, Crabbe D, Janes SM, De Coppi P, Lowdell MW, Birchall MA. Tracheal Replacement Therapy with a Stem Cell-Seeded Graft: Lessons from Compassionate Use Application of a GMP-Compliant Tissue-Engineered Medicine. Stem Cells Transl Med 2019; 6:1458-1464. [PMID: 28544662 PMCID: PMC5689750 DOI: 10.1002/sctm.16-0443] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/03/2017] [Indexed: 12/15/2022] Open
Abstract
Tracheal replacement for the treatment of end‐stage airway disease remains an elusive goal. The use of tissue‐engineered tracheae in compassionate use cases suggests that such an approach is a viable option. Here, a stem cell‐seeded, decellularized tissue‐engineered tracheal graft was used on a compassionate basis for a girl with critical tracheal stenosis after conventional reconstructive techniques failed. The graft represents the first cell‐seeded tracheal graft manufactured to full good manufacturing practice (GMP) standards. We report important preclinical and clinical data from the case, which ended in the death of the recipient. Early results were encouraging, but an acute event, hypothesized to be an intrathoracic bleed, caused sudden airway obstruction 3 weeks post‐transplantation, resulting in her death. We detail the clinical events and identify areas of priority to improve future grafts. In particular, we advocate the use of stents during the first few months post‐implantation. The negative outcome of this case highlights the inherent difficulties in clinical translation where preclinical in vivo models cannot replicate complex clinical scenarios that are encountered. The practical difficulties in delivering GMP grafts underscore the need to refine protocols for phase I clinical trials. Stem Cells Translational Medicine2017;6:1458–1464
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Affiliation(s)
- Martin J Elliott
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Colin R Butler
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom.,Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | | | - Leanne Partington
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Carla Carvalho
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Edward Samuel
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Claire Crowley
- Department of Paediatric Surgery, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Peggy Lange
- Department of Surgical Research, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, United Kingdom
| | - Nicholas J Hamilton
- Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | - Tahera Ansari
- Department of Surgical Research, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, United Kingdom
| | - Paul Sibbons
- Department of Surgical Research, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, United Kingdom
| | - Anja Fierens
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Claire McLaren
- Department of Interventional Radiology, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Derek Roebuck
- Department of Interventional Radiology, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Colin Wallis
- Department of Respiratory Medicine, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Nagarajan Muthialu
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Richard Hewitt
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - David Crabbe
- Department of Paediatric Surgery, Leeds General Infirmary, Leeds, United Kingdom
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | - Paolo De Coppi
- Department of Paediatric Surgery, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Mark W Lowdell
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Martin A Birchall
- UCL Ear Institute and The Royal National Throat Nose and Ear Hospital, London, United Kingdom
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20
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Vu HV, Huynh QK, Nguyen VDQ. Surgical reconstruction for congenital tracheal malformation and pulmonary artery sling. J Cardiothorac Surg 2019; 14:49. [PMID: 30823928 PMCID: PMC6397439 DOI: 10.1186/s13019-019-0858-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 02/17/2019] [Indexed: 11/25/2022] Open
Abstract
Background Congenital tracheal malformations are less common than congenital cardiac diseases and surgical repair of these anomalies is complex. We sought to examine the surgical treatment and outcomes in cases of tracheal anomalies presenting with or without associated congenital malformations. Methods We retrospectively reviewed the demographic, clinical, and imaging data of 49 children who underwent surgery for congenital tracheal malformations between August 2013 and September 2017. Data were collected from the hospital records. Results In all, 49 patients (male, 30; female, 19) underwent surgeries at our center. The children were of ages between 3 and 36 months (average: 9.7 months). Associated congenital lesions included sling in31/49 (63%), vascularring: in 2/49; ventriculoseptaldefectin5/49; Fallot’s tetraology in 2/49 (4.1%), and imperforate anus in 3/49 (6.1%). The outcomes of surgery were excellent in 42(85.7%) cases, good in 3 cases, while mortality occurred in 4(8.1%) cases. All cases of tracheal stenosis without any change in tracheobronchial arborization, 10/12 cases of bridge carina, and all cases of tripod carina were reconstructed using the slide tracheoplasty technique. Antetracheal translocation was performed for correction of associated pulmonary sling, without reimplantation of the pulmonary artery. Conclusions Reconstructive surgery is a feasible treatment option for congenital tracheal malformations. Slide tracheoplasty can be safely applied in all cases for the correction of tracheal stenosis. Segment resection was not required for any portion of the trachea. Pulmonary artery translocation is safe and effective for patients with pulmonary artery sling, rather than reimplantation. Mortality was associated with severe cardiac complications.
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Affiliation(s)
- Huu Vinh Vu
- Department of Thoracic Surgery, Choray Hospital, Nguyen Chi Thanh street, District No. 5, Hochiminh City, Vietnam.
| | - Quang Khanh Huynh
- Department of Thoracic Surgery, Choray Hospital, Nguyen Chi Thanh street, District No. 5, Hochiminh City, Vietnam
| | - Viet Dang Quang Nguyen
- Department of Thoracic Surgery, Choray Hospital, Nguyen Chi Thanh street, District No. 5, Hochiminh City, Vietnam
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21
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Abstract
This article reviews congenital anomalies involving the larynx and trachea, including congenital subglottic stenosis, laryngeal webs, laryngeal cleft, and tracheal stenosis. Presenting signs and symptoms, prevailing surgical repair techniques, and postoperative care are discussed.
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Affiliation(s)
- April M Landry
- Department of Otolaryngology Head and Neck Surgery, Emory University, 1600 Tullie Road NE, Atlanta, GA 30329, USA.
| | - Michael J Rutter
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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22
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Schwartz IE, Utz ER, Gaudreau PA. Congenital complete absence of tracheal rings with trifurcate carina: Case report of a rare clinical and endoscopic presentation. Int J Pediatr Otorhinolaryngol 2018; 111:1-6. [PMID: 29958589 DOI: 10.1016/j.ijporl.2018.05.009] [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] [Received: 11/20/2017] [Revised: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 11/26/2022]
Abstract
We describe the case of a child with isolated absence of cartilaginous tracheal rings and a trifurcate carina. At 6 months of age, the patient presented to our multidisciplinary airway clinic with stridor and recurrent severe respiratory infections requiring hospitalization. Radiographs showed airway narrowing. Exam demonstrated biphasic stridor. Flexible fiberoptic laryngoscopy demonstrated only mild laryngomalacia. Operative bronchoscopy demonstrated severe tracheomalacia with absence of any visible tracheal rings and a trifurcate carina. Subsequent CT imaging corroborated these findings and did not demonstrate any other major abnormality. The patient did not require operative intervention and his subsequent course was uncomplicated.
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Affiliation(s)
- Isaac E Schwartz
- Department of Otolaryngology/Head & Neck Surgery, Naval Medical Center San Diego, San Diego, CA, United States.
| | - Edward R Utz
- Department of Otolaryngology/Head & Neck Surgery, Naval Medical Center San Diego, San Diego, CA, United States
| | - Philip A Gaudreau
- Department of Otolaryngology/Head & Neck Surgery, Naval Medical Center San Diego, San Diego, CA, United States
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23
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Abstract
Congenital malformations of the trachea include a variety of conditions that cause respiratory distress in neonates and infants. A number of anomalies are self-limiting while others are life-threatening and require immediate therapy. The prevalence of congenital airway malformations has been estimated to range between 0.2 and 1 in 10,000 live births. The most frequent congenital tracheal malformations are: tracheomalacia, congenital tracheal stenosis, laryngotracheal cleft and tracheal agenesis. The management of congenital tracheal malformations is complex and requires an individualized approach delivered by a multidiscipilinary team within centralized units with the necessary expertise.
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Affiliation(s)
- Patricio Varela
- Program Director Pediatric Airway Unit, Mackenna Children's Hospital, Clínica Las Condes Medical Center, University of Chile, Santiago, Chile.
| | - Michelle Torre
- Director Pediatric Airway Unit, Gaslinni Institute, Genoa, Italy
| | - Claudia Schweiger
- Pediatric Otolaryngology and Head and Neck Surgeon, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Hiroki Nakamura
- National Children's Research Centre, Our Lady's Children's Hospital, Dublin, Ireland
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24
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Sekioka A, Fukumoto K, Murata M, Fukuba R, Yamoto M, Takahashi T, Ohyama K, Nomura A, Yamada Y, Urushihara N. Complex surgical treatment of congenital tracheal stenosis with associated unilateral lung agenesis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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25
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Hou Q, Gao W, Zhong Y, Sun A, Wang Q, Hu L, Wang J. Diagnostic Accuracy of Three-dimensional Turbo Field Echo Magnetic Resonance Imaging Sequence in Pediatric Tracheobronchial Anomalies with Congenital Heart Disease. Sci Rep 2018; 8:2529. [PMID: 29416073 PMCID: PMC5803237 DOI: 10.1038/s41598-018-20892-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/23/2018] [Indexed: 12/29/2022] Open
Abstract
Tracheobronchial anomalies are common in congenital heart disease (CHD), including tracheobronchial stenosis, tracheal bronchus, cardiac bronchus, and bronchial isomerism, which can cause varying degrees of respiratory illness. It is necessary to assess tracheobronchial anomalies and make a preoperative airway evaluation. Multi-slice computed tomography (MSCT) and cardiac magnetic resonance imaging (MRI) are the most effective noninvasive modalities for the diagnosis of CHD and the associated tracheobronchial anomalies. However, MSCT remains an ionizing procedure despite using low dose protocols. The aim of this study was to evaluate diagnostic accuracy of tracheobronchial anomalies in patients with CHD using three-dimensional turbo field echo(3D-TFE) magnetic resonance imaging sequence for preoperative airway evaluation. The results indicated that 3D-TFE provided better image quality as compared to that of 3D-balanced turbo field echo (3D-bTFE), and it can clearly demonstrated the tracheobronchial tree and tracheobronchial anomalies in CHD. This study confirms the clinical value of 3D-TFE in diagnosing tracheobronchial anomalies and supply helpful tracheobronchial information for preoperative strategies and postoperative follow-up.
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Affiliation(s)
- QiaoRu Hou
- Diagnostic imaging Center of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Wei Gao
- Department of Pediatric Cardiology of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China
| | - YuMin Zhong
- Diagnostic imaging Center of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China.
| | - AiMin Sun
- Diagnostic imaging Center of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Qian Wang
- Diagnostic imaging Center of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China
| | - LiWei Hu
- Diagnostic imaging Center of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China
| | - JingLei Wang
- Diagnostic imaging Center of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China
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26
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Ragalie WS, Chun RH, Martin T, Ghanayem NS, Berens RJ, Beste DJ, Mitchell ME. Side-to-Side Tracheobronchoplasty to Reconstruct Complex Congenital Tracheobronchial Stenosis. Ann Thorac Surg 2017; 104:666-673. [DOI: 10.1016/j.athoracsur.2017.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/30/2016] [Accepted: 01/03/2017] [Indexed: 11/24/2022]
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27
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Elliott MJ, Butler CR, Varanou-Jenkins A, Partington L, Carvalho C, Samuel E, Crowley C, Lange P, Hamilton NJ, Hynds RE, Ansari T, Sibbons P, Fierens A, McLaren C, Roebuck D, Wallis C, Muthialu N, Hewitt R, Crabbe D, Janes SM, De Coppi P, Lowdell MW, Birchall MA. Tracheal Replacement Therapy with a Stem Cell-Seeded Graft: Lessons from Compassionate Use Application of a GMP-Compliant Tissue-Engineered Medicine. Stem Cells Transl Med 2017. [PMID: 28544662 DOI: 10.1002/sctm.16-0443.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tracheal replacement for the treatment of end-stage airway disease remains an elusive goal. The use of tissue-engineered tracheae in compassionate use cases suggests that such an approach is a viable option. Here, a stem cell-seeded, decellularized tissue-engineered tracheal graft was used on a compassionate basis for a girl with critical tracheal stenosis after conventional reconstructive techniques failed. The graft represents the first cell-seeded tracheal graft manufactured to full good manufacturing practice (GMP) standards. We report important preclinical and clinical data from the case, which ended in the death of the recipient. Early results were encouraging, but an acute event, hypothesized to be an intrathoracic bleed, caused sudden airway obstruction 3 weeks post-transplantation, resulting in her death. We detail the clinical events and identify areas of priority to improve future grafts. In particular, we advocate the use of stents during the first few months post-implantation. The negative outcome of this case highlights the inherent difficulties in clinical translation where preclinical in vivo models cannot replicate complex clinical scenarios that are encountered. The practical difficulties in delivering GMP grafts underscore the need to refine protocols for phase I clinical trials. Stem Cells Translational Medicine 2017;6:1458-1464.
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Affiliation(s)
- Martin J Elliott
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Colin R Butler
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom.,Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | | | - Leanne Partington
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Carla Carvalho
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Edward Samuel
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Claire Crowley
- Department of Paediatric Surgery, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Peggy Lange
- Department of Surgical Research, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, United Kingdom
| | - Nicholas J Hamilton
- Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | - Tahera Ansari
- Department of Surgical Research, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, United Kingdom
| | - Paul Sibbons
- Department of Surgical Research, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, United Kingdom
| | - Anja Fierens
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Claire McLaren
- Department of Interventional Radiology, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Derek Roebuck
- Department of Interventional Radiology, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Colin Wallis
- Department of Respiratory Medicine, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Nagarajan Muthialu
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Richard Hewitt
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - David Crabbe
- Department of Paediatric Surgery, Leeds General Infirmary, Leeds, United Kingdom
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | - Paolo De Coppi
- Department of Paediatric Surgery, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Mark W Lowdell
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Martin A Birchall
- UCL Ear Institute and The Royal National Throat Nose and Ear Hospital, London, United Kingdom
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The role of adjunctive procedures in reducing postoperative tracheobronchial obstruction in single lung patients with congenital tracheal stenosis undergoing slide tracheoplasty. J Pediatr Surg 2017; 52:677-679. [PMID: 28185629 DOI: 10.1016/j.jpedsurg.2017.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/23/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Congenital tracheal stenosis (CTS) and a single right lung treated with slide tracheoplasty (ST) has relatively high rates of mortality and morbidity. We report a single institution's experience with adjunctive procedures at the time of ST to reduce postoperative tracheal obstruction in patients with a single right lung and CTS. METHODS With IRB approval, 8 patients with a single right lung and CTS who underwent ST in our institution between 2008 and 2016 were reviewed. RESULTS Seven of 8 patients (88%) survived, with a median follow-up period of 35 (3-89) months. The only mortality was because of complications unrelated to the airway. Six of 8 patients underwent ST anterior to the aortic arch (tracheal translocation, TT). This was combined with tracheopexy concomitantly in 3 patients and subsequently in one patient. Two patients had insufficient tracheal length for TT. Both underwent aortopexy. Of three patients undergoing TT with tracheopexy concomitantly, two have been successfully extubated, and a third has required tracheostomy for subglottic stenosis. All patients undergoing TT without tracheopexy have experienced severe tracheobronchomalacia. CONCLUSION We conclude that adjunctive TT with tracheopexy might be associated with lower rates of tracheobronchial obstruction in patients with a single right lung undergoing ST for CTS. LEVEL OF EVIDENCE Level IV.
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Abstract
Pediatric airway surgery is a challenging field in pediatric surgery. Laryngotracheal stenosis has a variety of congenital and acquired conditions that require precise assessment and tailored treatment for each individual patient. About 90% of acquired conditions are represented by subglottic stenosis (SGS) resulting as a complication of tracheal intubation. Congenital tracheal stenosis (CTS) is a rare and life-threatening malformation, usually associated with complete tracheal rings along a variable length of the trachea. Tracheomalacia (TM) is a process characterized by flaccidity of the supporting tracheal cartilage, widening of the posterior membranous wall, and reduced anterior-posterior airway caliber. The clinical presentation can vary from almost asymptomatic patients to near fatal airway obstruction. There is considerable variation in both the morphologic subtypes and the prognosis of pediatric airway. The patients are divided into three clinical groups (mild, moderate, and severe). A further division was proposed according to the presence or absence of associated anomalies. The definitive diagnosis of pediatric airway was made by means of rigid bronchoscope and computed tomography scan with three-dimensional reconstruction (3D-CT). Rigid bronchoscopy and 3D-CT confirmed the diagnosis in all the cases. Other associated anomalies include congenital heart disease, vascular anomalies, and BPFM (maldevelopment of aerodigestive tract). After definitive diagnosis of pediatric airway lesions, surgical intervention should be considered. Surgical strategy was presented on each lesion.
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Affiliation(s)
- Kosaku Maeda
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
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Stagnaro N, Rizzo F, Torre M, Cittadini G, Magnano G. Multimodality imaging of pediatric airways disease: indication and technique. Radiol Med 2017; 122:419-429. [PMID: 28224400 DOI: 10.1007/s11547-017-0737-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/31/2017] [Indexed: 01/09/2023]
Abstract
Congenital and acquired airway anomalies represent a relatively common albeit diagnostic and therapeutic challenge, even for the most skilled operators in dedicated centers. Airway malformations encompass a wide spectrum of pathologies involving the larynx, trachea and bronchi, esophagus, mediastinal vessels. These developmental lesions are often isolated but the association of two or more anomalies is not infrequent. From the traditional chest X-ray to the newest applications of Optical Coherence Tomography, non- or mini-invasive diagnostic techniques represent useful tools to integrate invasive procedures. Comprehensive knowledge of the characteristics of each diagnostic test is mandatory for its useful application. The aim of our paper is to analyze the clinical indications for Imaging the Airway disease in pediatric population, and describe the diagnostic techniques. Only by a close interaction between all the operators involved in diagnosis and treatment of pediatric airway, as it happens in Multidisciplinary Airway Team, the non- or mini-invasive imaging is effective.
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Affiliation(s)
- Nicola Stagnaro
- Radiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Francesca Rizzo
- Radiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Michele Torre
- Airway Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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31
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Congenital tracheal stenosis associated with left pulmonary artery sling accompanied by tracheal diverticula: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2016.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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32
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Mok Q. Airway Problems in Neonates-A Review of the Current Investigation and Management Strategies. Front Pediatr 2017; 5:60. [PMID: 28424763 PMCID: PMC5371593 DOI: 10.3389/fped.2017.00060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/10/2017] [Indexed: 11/20/2022] Open
Abstract
Airway problems in the neonatal population are often life threatening and raise challenging issues in diagnosis and management. The airway problems can result from congenital or acquired lesions and can be broadly classified into those causing obstruction or those due to an abnormal "communication" in the airway. Many different investigations are now available to identify the diagnosis and quantify the severity of the problem, and these tests can be simple or invasive. Bronchography and bronchoscopy are essential to determine the extent and severity of the airway problem and to plan treatment strategy. Further imaging techniques help to delineate other commonly associated abnormalities. Echocardiography is also important to confirm any associated cardiac abnormality. In this review, the merits and disadvantages of the various investigations now available to the clinician will be discussed. The current therapeutic strategies are discussed, and the review will focus on the most challenging conditions that cause the biggest management conundrums, specifically laryngotracheal cleft, congenital tracheal stenosis, and tracheobronchomalacia. Management of acquired stenosis secondary to airway injury from endotracheal intubation will also be discussed as this is a common problem. Slide tracheoplasty is the preferred surgical option for long-segment tracheal stenosis, and results have improved significantly. Stents are occasionally required for residual or recurrent stenosis following surgical repair. There is sufficient evidence that a multidisciplinary team approach for managing complex airway issues provides the best results for the patient. There is ongoing progress in the field with newer diagnostic tools as well as development of innovative management techniques, such as biodegradable stents and stem cell-based tracheal transplants, leading to a much better prognosis for these children in the future.
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Affiliation(s)
- Quen Mok
- Pediatric and Neonatal Intensive Care Units, Critical Care Division, Great Ormond Street Hospital for Children, London, UK
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34
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Morita K, Yokoi A, Fukuzawa H, Hisamatsu C, Endo K, Okata Y, Tamaki A, Mishima Y, Oshima Y, Maeda K. Surgical intervention strategies for congenital tracheal stenosis associated with a tracheal bronchus based on the location of stenosis. Pediatr Surg Int 2016; 32:915-9. [PMID: 27457232 DOI: 10.1007/s00383-016-3928-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to determine the appropriate surgical intervention strategies for congenital tracheal stenosis (CTS) associated with a tracheal bronchus based on the location of stenosis. METHODS The medical records of 13 pediatric patients with CTS associated with a tracheal bronchus at a single institution between January 2006 and December 2015 were retrospectively reviewed. RESULTS Type 1: tracheal stenosis above the right upper lobe bronchus (RULB) (n = 1). One patient underwent slide tracheoplasty and was successfully extubated. Type 2: tracheal stenosis below the RULB (n = 7). Tracheal end-to-end anastomosis was performed before 2014, and one patient failed to extubate. Posterior-anterior slide tracheoplasty was performed since 2014, and all three patients were successfully extubated. Type 3: tracheal stenosis above the RULB to the carina (n = 5). One patient underwent posterior-anterior slide tracheoplasty and was successfully extubated. Two patients with left-right slide tracheoplasty and another two patients with tracheal end-to-end anastomosis for the stenosis below the RULB could not be extubated. CONCLUSION Tracheal end-to-end anastomosis or slide tracheoplasty can be selected for tracheal stenosis above the RULB according to the length of stenosis. Posterior-anterior slide tracheoplasty appears feasible for tracheal stenosis below the RULB or above the RULB to the carina.
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Affiliation(s)
- Keiichi Morita
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Hiroaki Fukuzawa
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Chieko Hisamatsu
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Kosuke Endo
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yuichi Okata
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Akihiko Tamaki
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yasuhiko Mishima
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yoshihiro Oshima
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Kosaku Maeda
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
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Abstract
The term vascular ring refers to congenital vascular anomalies of the aortic arch system that compress the esophagus and trachea, causing symptoms related to those two structures. The most common vascular rings are double aortic arch and right aortic arch with left ligamentum. Pulmonary artery sling is rare and these patients need to be carefully evaluated for frequently associated tracheal stenosis. Another cause of tracheal compression occurring only in infants is the innominate artery compression syndrome. In the current era, the diagnosis of a vascular ring is best established by CT imaging that can accurately delineate the anatomy of the vascular ring and associated tracheal pathology. For patients with a right aortic arch there recently has been an increased recognition of a structure called a Kommerell diverticulum which may require resection and transfer of the left subclavian artery to the left carotid artery. A very rare vascular ring is the circumflex aorta that is now treated with the aortic uncrossing operation. Patients with vascular rings should all have an echocardiogram because of the incidence of associated congenital heart disease. We also recommend bronchoscopy to assess for additional tracheal pathology and provide an assessment of the degree of tracheomalacia and bronchomalacia. The outcomes of surgical intervention are excellent and most patients have complete resolution of symptoms over a period of time.
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Affiliation(s)
- Carl L Backer
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 22, 225 E. Chicago Ave, Chicago, Illinois 60611; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Michael C Mongé
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 22, 225 E. Chicago Ave, Chicago, Illinois 60611; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrada R Popescu
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Osama M Eltayeb
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 22, 225 E. Chicago Ave, Chicago, Illinois 60611; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey C Rastatter
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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36
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Abstract
Congenital tracheobronchial stenosis is a rare disease characterized by complete tracheal rings that can affect variable lengths of the tracheobronchial tree. It causes high levels of morbidity and mortality both due to the stenosis itself and to the high incidence of other associated congenital malformations. Successful management of this complex condition requires a highly individualized approach delivered by an experienced multidisciplinary team, which is best delivered within centralized units with the necessary diverse expertise. In such settings, surgical correction by slide tracheoplasty has become increasingly successful over the past 2 decades such that long-term survival now exceeds 88%, with normalization of quality of life scores for patients with non-syndrome-associated congenital tracheal stenosis. Careful assessment and planning of treatment strategies is of paramount importance for both successful management and the provision of patients and carers with accurate and realistic treatment counseling.
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Affiliation(s)
- Richard J Hewitt
- Department of Ear, Nose and Throat Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Colin R Butler
- Department of Ear, Nose and Throat Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Department of Paediatric Surgery, Stem Cell and Regernerative Medicine Group, UCL Institute of Child Health, London, UK; Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Elizabeth F Maughan
- Department of Paediatric Surgery, Stem Cell and Regernerative Medicine Group, UCL Institute of Child Health, London, UK; Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Martin J Elliott
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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37
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Abstract
Tracheobronchial obstruction is infrequent in children and still remains a challenging matter of concern. Management alternatives vary from conservative treatment to complex surgical techniques or endoscopic interventional procedures. Airway stenting in children is relatively recent and follows the trail of the experience in adult patients. Nevertheless, there are basic differences between both age groups like the benign nature of most obstructions and the small size of the pediatric airway. These specific features raise the issues of the precise role of tracheobronchial stenting in children and the selection of the most adequate device. Stents fall into four main categories according to the material they are made of: metallic, plastic, hybrid, and biodegradable. Each type has its own advantages and drawbacks so the ideal stent is not yet available. Despite increasing experience with stenting, definite clinical criteria for their use in children are yet to be established. Even so, there seems to be a basic general agreement that stents may play a role in particular clinical settings in which there are no other therapeutic options.
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Affiliation(s)
- Juan L Antón-Pacheco
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, c/Vallehermoso 20. 7º A, izda, Madrid 28015, Spain.
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38
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Chao YC, Peng CC, Lee KS, Lin SM, Chen MR. The association of congenital tracheobronchial stenosis and cardiovascular anomalies. Int J Pediatr Otorhinolaryngol 2016; 83:1-6. [PMID: 26968043 DOI: 10.1016/j.ijporl.2016.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Congenital tracheobronchial stenosis (CTBS) is a rare disorder characterized by the presence of focal or diffuse complete tracheal or bronchial cartilage rings resulting in a fixed lumen narrowing. The aim of this study was to expose the association of various cardiovascular (CV) anomalies with various types of CTBS. METHODS A retrospective review of 58 patients who had bronchoscopically proven CTBS between 1997 and 2011 was conducted. Totally, 48 cases who had received echocardiography, computed tomography and other examinations including cardiac catheterization were enrolled. There were 33 boys and 15 girls, and the median age of diagnosis was 4 months (0-44 months). The image findings of associated CV anomalies were reviewed and analyzed, along with the clinical manifestations and patients' outcome. RESULTS There were 14 generalized hypoplasia (29.2%), 10 funnel type (20.8%), 15 segmental type (31.3%), and 9 isolated bronchial stenosis cases (18.7%). Among 48 cases of CTBS, 32 patients (66.7%) had various CV anomalies including atrial septal defect (n=9), pulmonary artery sling (n=7), ventricular septal defect (n=7), patent ductus arteriosus (n=6), tetralogy of Fallot (n=3), peripheral pulmonary stenosis (n=3), etc. No significant difference existed in the incidence and types of comorbid CV anomalies among 4 types of CTBS, except that funnel type had significantly higher comorbidity of pulmonary artery sling (50%, p<0.01). CONCLUSION Patients with CTBS had high incidence of various associated CV anomalies. Isolated bronchial stenosis had similar high comorbidity of CV anomalies as did the 3 classical categories of congenital tracheal stenosis. The higher comorbidity of pulmonary artery sling in patients with funnel CTBS might be related to its gradual caudal narrowing of the trachea.
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Affiliation(s)
- Yen-Chun Chao
- Department of Pediatrics, Mackay Children's Hospital, Taipei, Taiwan
| | - Chun-Chin Peng
- Department of Pediatrics, Mackay Children's Hospital, Taipei, Taiwan
| | - Kuo-Sheng Lee
- Department of Otorhinolaryngolaryngology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shan-Miao Lin
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ming-Ren Chen
- Department of Pediatrics, Mackay Children's Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan.
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Speggiorin S, Durairaj S, Mimic B, Corno AF. Virtual 3D Modeling of Airways in Congenital Heart Defects. Front Pediatr 2016; 4:116. [PMID: 27833903 PMCID: PMC5080340 DOI: 10.3389/fped.2016.00116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 10/10/2016] [Indexed: 11/13/2022] Open
Abstract
The involvement of the airway is not uncommon in the presence of complex cardiovascular malformations. In these cases, a careful inspection of the relationship between the airway and the vasculature is paramount to plan the surgical procedure. Three-dimensional printing enhanced the visualization of the cardiovascular structure. Unfortunately, IT does not allow to remove selected anatomy to improve the visualization of the surrounding ones. Computerized modeling has the potential to fill this gap by allowing a dynamic handling of different anatomies, increasing the exposure of vessels or bronchi to show their relationship. We started to use this technique to plan the surgical repair in these complex cases where the airway is affected. This technique is routinely used in our Institution as an additional tool in the presurgical assessment. We report four cases in which the airways were compressed by vascular structures - ascending aorta in one, left pulmonary artery sling in one, patent ductus arteriosus in one, and major aorto-pulmonary collateral artery in one. We believe this technique can enhance the understanding of the causes of airway involvement and facilitate the creation of an appropriate surgical plan.
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Affiliation(s)
- Simone Speggiorin
- Department of Pediatric and Congenital Cardiac Surgery, East Midlands Congenital Heart Centre, Glenfield Hospital , Leicester , UK
| | - Saravanan Durairaj
- Department of Pediatric Cardiology, East Midlands Congenital Heart Centre, Glenfield Hospital , Leicester , UK
| | - Branko Mimic
- Department of Pediatric and Congenital Cardiac Surgery, East Midlands Congenital Heart Centre, Glenfield Hospital , Leicester , UK
| | - Antonio F Corno
- Department of Pediatric and Congenital Cardiac Surgery, East Midlands Congenital Heart Centre, Glenfield Hospital , Leicester , UK
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Hofferberth SC, Watters K, Rahbar R, Fynn-Thompson F. Evolution of Surgical Approaches in the Management of Congenital Tracheal Stenosis. World J Pediatr Congenit Heart Surg 2015; 7:16-24. [DOI: 10.1177/2150135115606627] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Congenital tracheal stenosis (CTS) is a serious and rare condition that often presents a complex surgical challenge. We reviewed the evolution of surgical approaches to the management of CTS at a single institution. Methods: We conducted a retrospective clinical review of all patients who underwent surgical repair of CTS at our institution. From January 1992 to January 2014, a total of 30 patients (median age 92 days; range 3 days-1.7 years) underwent surgery for CTS at our institution. Techniques included slide tracheoplasty (n = 16), tracheal resection (n = 10), pericardial patch tracheoplasty (n = 3), and costal cartilage tracheoplasty (n = 1). Twenty-two (73%) patients had associated intracardiac or great vessel anomalies, including 18 (60%) with left pulmonary artery sling. Five (17%) patients had associated single lung malformation. All procedures were performed via a median sternotomy with cardiopulmonary bypass. Results: Median postoperative length of stay was 25 days (range, 5-431 days). Late airway reintervention was required in seven (26%), including two (15%) infants after slide tracheoplasty, two (22%) posttracheal resection, and two (100%) post pericardial patch tracheoplasty. The one patient who underwent costal cartilage tracheoplasty required multiple reinterventions. Overall mortality was 13% (n = 4), two deaths occurred post slide tracheoplasty, one death occurred after tracheal resection, and one after pericardial patch tracheoplasty, respectively. Conclusion: Slide tracheoplasty is the procedure of choice for repair of CTS, while tracheal resection is a viable option for patients with discreet, short-segment stenosis.
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Affiliation(s)
- Sophie C. Hofferberth
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Karen Watters
- Department of Otolaryngology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Reza Rahbar
- Department of Otolaryngology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Francis Fynn-Thompson
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Bhat V, Gadabanahalli K, Ahmad O. Tracheal quadrifurcation associated with congenital heart disease. Pediatr Radiol 2015; 45:1236-8. [PMID: 25779829 DOI: 10.1007/s00247-015-3309-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/22/2015] [Accepted: 02/05/2015] [Indexed: 11/26/2022]
Abstract
Tracheal anomalies are known in association with congenital cardiac defects. Some of the well-described anomalies include accessory (displaced) tracheal bronchus with variants, tracheal trifurcation and accessory cardiac bronchus. Here we describe a case of tracheal quadrifurcation associated with complex congenital heart disease. Illustration of complex airway anatomy was simplified by the use of multidetector CT using a variety of image display options. Awareness of this complex anomaly will expand our knowledge of tracheal anomalies and equip the anesthesia and surgical team for better airway management.
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Affiliation(s)
- Venkatraman Bhat
- Department of Radiology, Narayana Multispeciality Hospital and Mazumdar Shaw Cancer Center, Bommasandra, Bangalore, India,
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42
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Hegde SV, Hui PK, Lee EY. Tracheobronchial Foreign Bodies in Children: Imaging Assessment. Semin Ultrasound CT MR 2015; 36:8-20. [DOI: 10.1053/j.sult.2014.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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43
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Murata H, Yoshida M, Ichinomiya T, Shibata I, Hara T. Combined airwayscope and fiberoptic bronchoscopic airway management in a patient with a tracheal bronchus. J Cardiothorac Vasc Anesth 2015; 29:e19-20. [PMID: 25596007 DOI: 10.1053/j.jvca.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Hiroaki Murata
- Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Misao Yoshida
- Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Taiga Ichinomiya
- Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Itsuko Shibata
- Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Tetsuya Hara
- Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan
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Stock C, Nathan M, Murray R, Rahbar R, Fynn-Thompson F. Modified End-to-End Anastomosis for the Treatment of Congenital Tracheal Stenosis With a Bridging Bronchus. Ann Thorac Surg 2015; 99:346-8. [DOI: 10.1016/j.athoracsur.2014.06.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/18/2014] [Accepted: 06/27/2014] [Indexed: 11/26/2022]
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Hart CK, Rutter MJ. Tracheobronchial issues in congenital heart disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2015; 18:57-61. [PMID: 25939844 DOI: 10.1053/j.pcsu.2014.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/04/2014] [Indexed: 06/04/2023]
Abstract
In children with congenital heart disease, tracheobronchial compromise is uncommon but potentially life-threatening. Airway lesions in these patients may be congenital or acquired, and may be stenotic, compressive, or malacic in nature. We present an overview of the etiologies of tracheobronchial lesions typically seen in children with congenital heart disease and review management options for these lesions.
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Affiliation(s)
- Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
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Wu ET, Yang MC, Wang CC, Lin MT, Chen SJ, Huang CH, Hwang HK, Chen MR, Huang SC. Congenital Right Intermediate Bronchial Stenosis With Carina Trifurcation: Successful Management With Slide Tracheobronchial Plasty. Ann Thorac Surg 2014; 98:357-9. [DOI: 10.1016/j.athoracsur.2013.11.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/16/2013] [Accepted: 11/25/2013] [Indexed: 11/30/2022]
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Butler CR, Speggiorin S, Rijnberg FM, Roebuck DJ, Muthialu N, Hewitt RJ, Elliott MJ. Outcomes of slide tracheoplasty in 101 children: A 17-year single-center experience. J Thorac Cardiovasc Surg 2014; 147:1783-9. [DOI: 10.1016/j.jtcvs.2014.02.069] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 02/18/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
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Amendola RL, Reinhardt JM, Zimmerman MB, Sato Y, Diggelmann HR, Kacmarynski DSF. Development of a preliminary pediatric tracheal growth model from magnetic resonance images. Laryngoscope 2014; 124:1947-51. [DOI: 10.1002/lary.24547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 11/06/2013] [Accepted: 11/27/2013] [Indexed: 01/10/2023]
Affiliation(s)
- Richard L. Amendola
- Department of Otolaryngology-Head and Neck Surgery; University of Iowa; Iowa City Iowa U.S.A
| | - Joseph M. Reinhardt
- Department of Biomedical Engineering; University of Iowa; Iowa City Iowa U.S.A
| | | | - Yutaka Sato
- Division of Pediatric Radiology; Department of Radiology; University of Iowa; Iowa City Iowa U.S.A
| | - Henry R. Diggelmann
- Department of Otolaryngology-Head and Neck Surgery; University of Iowa; Iowa City Iowa U.S.A
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Wu ET, Wang CC, Lin MT, Huang PM, Chen SJ, Huang CH, Hwang HK, Chen MR, Huang SC. Concomitant Slide Tracheoplasty and Cardiac Operation for Congenital Tracheal Stenosis Associated With VACTERL. Ann Thorac Surg 2013; 96:1492-1495. [DOI: 10.1016/j.athoracsur.2013.04.122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 04/08/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
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Miyazaki T, Yamasaki N, Tsuchiya T, Matsumoto K, Hayashi H, Izumikawa K, Izumikawa K, Nagayasu T. Partial lung resection of supernumerary tracheal bronchus combined with pulmonary artery sling in an adult: report of a case. Gen Thorac Cardiovasc Surg 2013; 63:173-6. [PMID: 23852428 DOI: 10.1007/s11748-013-0287-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 07/06/2013] [Indexed: 11/30/2022]
Abstract
An adult case of pulmonary resection for repeated infections in a supernumerary tracheal bronchus combined with a pulmonary artery sling is reported. A 33-year-old woman with a pulmonary artery sling was referred for recurrent lung infections. Chest computed tomography showed the left pulmonary artery arising from the right pulmonary artery and coursing posterior to the trachea. The lung parenchyma connected to the tracheal bronchus showed dense opacity and traction bronchiectasis. Partial pulmonary resection was performed with an ultrasonically activated scalpel after the tracheal bronchus was auto-sutured. The patient's postoperative course was uneventful, and she is now in good condition.
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Affiliation(s)
- Takuro Miyazaki
- Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan,
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