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Karkhanis T, Byju AG, Morales DL, Zafar F, Haridas B. Composite Biosynthetic Graft for Repair of Long-Segment Tracheal Stenosis: A Pilot In Vivo and In Vitro Feasibility Study. ASAIO J 2024; 70:527-534. [PMID: 38170278 PMCID: PMC11139240 DOI: 10.1097/mat.0000000000002130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Pediatric patients who undergo surgery for long-segment congenital tracheal stenosis (LSCTS) have suboptimal outcomes and postsurgical complications. To address this, we propose a biosynthetic graft comprising (1) a porcine small intestinal submucosa extracellular matrix (SIS-ECM) patch for tracheal repair, and (2) a resorbable polymeric exostent for biomechanical support. The SIS-ECM patch was evaluated in vivo in an ovine trachea model over an 8 month period. Concurrently, the biosynthetic graft was evaluated in a benchtop lamb trachea model for biomechanical stability. In vivo results show that SIS-ECM performs better than bovine pericardium (control) by preventing granulation tissue/restenosis, restoring tracheal architecture, blood vessels, matrix components, pseudostratified columnar and stratified epithelium, ciliary structures, mucin production, and goblet cells. In vitro tests show that the biosynthetic graft can provide the desired axial and flexural stability, and biomechanical function approaching that of native trachea. These results encourage future studies to evaluate safety and efficacy, including biomechanics and collapse risk, biodegradation, and in vivo response enabling a stable long-term tracheal repair option for pediatric patients with LSCTS and other tracheal defects.
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Affiliation(s)
- Teja Karkhanis
- From the Department of Biomedical Engineering, Texas A&M University, College Station, Texas
| | - Achu G. Byju
- From the Department of Biomedical Engineering, Texas A&M University, College Station, Texas
| | | | - Farhan Zafar
- Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Balakrishna Haridas
- From the Department of Biomedical Engineering, Texas A&M University, College Station, Texas
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Nakatani T, Morita K, Yokoi A, Hatakeyama T. Long- term outcomes of congenital tracheal stenosis after slide tracheoplasty. Pediatr Surg Int 2024; 40:84. [PMID: 38507085 DOI: 10.1007/s00383-024-05670-8] [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] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Long-term outcomes of slide tracheoplasty in patients with congenital tracheal stenosis (CTS) have rarely been reported. This study aimed to clarify the long-term outcomes of CTS after slide tracheoplasty. METHODS The medical records of 33 patients who underwent slide tracheoplasty for CTS at our institution between January 2005 and July 2018, with a follow-up duration > 5 years, were retrospectively reviewed. Patients' characteristics, perioperative condition, operative management, postoperative course, tracheal stenosis rates and growth data, were collected from medical records. RESULTS The median operative age, minimum tracheal diameter, length of stenosis, duration of hospital stays, and follow-up duration were 8 months, 2.4 mm, 35 mm, 39 days, and 90 months, respectively. One patient died of bleeding in the right lung at 126 months postoperatively. Among the 10 patients requiring postoperative tracheostomy, seven were successfully decannulated at a median of 65 months postoperatively. Tracheal stenosis rates improved postoperatively and were subsequently maintained. Growth impairment and psychomotor delay were observed in 9 and 16 patients, respectively with significant differences found only in cases with genetic abnormalities and not in tracheal stenosis severity. CONCLUSION Slide tracheoplasty for CTS leads to favorable long-term outcomes. However, various associated anomalies may influence growth and psychomotor development, emphasizing the importance of adequate support.
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Affiliation(s)
- Taichi Nakatani
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojima-minamimachi, Chuo-ku, Kobe-shi, Japan
| | - Keiichi Morita
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojima-minamimachi, Chuo-ku, Kobe-shi, Japan.
| | - Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojima-minamimachi, Chuo-ku, Kobe-shi, Japan
| | - Tadashi Hatakeyama
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojima-minamimachi, Chuo-ku, Kobe-shi, Japan
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Zhou M, Zhong LL, Huang H, Lin L, Chen M, Ding XF. [The role of bronchoscopy in slide tracheoplasty in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:527-533. [PMID: 37272181 DOI: 10.7499/j.issn.1008-8830.2211012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To study the role of bronchoscopy in slide tracheoplasty. METHODS A retrospective analysis was conducted on the diagnosis and treatment of four children with tracheal stenosis admitted to Hunan Provincial People's Hospital from 2017 to 2020. The role of bronchoscopy was summarized in the preoperative evaluation, intraoperative positioning and measurement, and postoperative wound evaluation and treatment during slide tracheoplasty. RESULTS Bronchoscopy evaluation before slide tracheoplasty showed that 3 of the 4 children had complete trachea rings, 2 had pulmonary artery sling, and 2 had multiple stenosis. Slide tracheoplasty was performed in the hospital on 3 children, and the midpoint of the stenosis segment was judged under bronchoscopy, and the length of the stenosis segment was measured, which assisted in the resection of the stenosis segment of the trachea. The pathogens were identified by lavage after the surgery. One child who developed scar traction 9 months after slide tracheoplasty in another hospital was improved by interventional treatment under bronchoscopy. Mucosal changes were found under bronchoscopy in 2 children 4 days after surgery, and the treatment plan was adjusted. One month after surgery, 2 children had granulation hyperplasia, which was improved by cryotherapy under bronchoscopy. One child abandoned treatment due to anastomotic necrosis and died. Three survivors were followed up for over 6 months with good prognosis, but all had tracheobronchial malacia. CONCLUSIONS Bronchoscopy can be used for the management of slide tracheoplasty in children with tracheal stenosis, which is helpful to postoperative rehabilitation and follow-up.
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Affiliation(s)
- Miao Zhou
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Li-Li Zhong
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Han Huang
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Lin Lin
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Min Chen
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Xiao-Fang Ding
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
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Lava CX, Martin TS, Leonard JA, Blumenthal DL, Scriven‐Weiner K, Chu E, Harley EH. Complications associated with costal cartilage harvest in pediatric laryngotracheal reconstruction. Laryngoscope Investig Otolaryngol 2023; 8:584-590. [PMID: 37090864 PMCID: PMC10116967 DOI: 10.1002/lio2.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 03/08/2023] Open
Abstract
Objective We aimed to determine the rate of complications associated with autologous costal cartilage graft harvest for pediatric laryngotracheal reconstruction (LTR). Secondarily, we sought to identify risk factors associated with the harvest of autologous costal cartilage, as well as evaluate management strategies. Data Sources An electronic database search of Ovid MEDLINE, Ovid EMBASE, and PubMed was completed for articles pertaining to complications in autologous costal cartilage harvest for pediatric LTR. Review Methods This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The study characteristics, operative information, and patient demographics were collected. The data concerning postoperative complications, risk factors, and management strategies were collected and analyzed for patterns. Results A total of 31 manuscripts representing 745 patients were included for analysis. The reported donor site complications included pneumothorax (n = 13, 1.74%), pleural tear (n = 5, 0.67%), infection (n = 8, 1.07%), and scar-related problems (n = 2, 0.26%). There were no reported cases of seroma, persistent pain, or chest wall deformity. Only five studies discussed the management of donor site complications, with intervention in 11 (39.28%) patients including chest tube drainage and steroid injection. Conclusion There is significant variability in the literature regarding complication rates in autologous costal cartilage harvest for pediatric LTR. The incidence of major postoperative complications is low and supports the use of autologous costal cartilage as graft material for pediatric LTR. Level of Evidence NA.
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Affiliation(s)
| | | | - James A. Leonard
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
| | - Daniel L. Blumenthal
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
| | - Kelly Scriven‐Weiner
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
| | - Eugenia Chu
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
| | - Earl H. Harley
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
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Surgical management of congenital tracheal stenosis associated with complex cardiovascular anomalies. Pediatr Surg Int 2022; 38:1903-1908. [PMID: 36083305 DOI: 10.1007/s00383-022-05206-y] [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: 08/26/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Although surgical outcomes have improved in patients with congenital tracheal stenosis (CTS), the management of such patients with complex cardiovascular anomalies (CVAs) remains a challenge. This study aimed to clarify the clinical features of this combination. METHODS Medical records of 14 patients with complex CVAs who had undergone slide tracheoplasty for CTS between May 2016 and February 2022 were retrospectively reviewed. Complex CVAs were defined as CVAs without left pulmonary artery sling and simple cardiac shunts. Data collected included age and body weight at tracheal reconstruction, preoperative respiratory support, surgery details, and mortality. RESULTS The median age and body weight at tracheal reconstruction were 3.5 (range, 1-17) months and 4.7 (range, 2.3-8.2) kg, respectively. Simultaneous repair of CTS and CVAs was performed in eight patients and staged repair in six patients. Patients who underwent simultaneous repair required preoperative respiratory support more frequently than those who underwent staged repair (8/8 [100%] vs 2/6 [33.3%]; P = 0.015). No mortality occurred. CONCLUSIONS Patients with complex CVAs often require tracheal reconstruction in early infancy. Surgical management strategy for this combination was generally decided on the basis of the severity of respiratory symptoms due to CTS.
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Kageyama S, Takeishi N, Harada N, Taniguchi K, Morita K, Wada S. Airway performance in infants with congenital tracheal stenosis associated with unilateral pulmonary agenesis: effect of tracheal shape on energy flux. Med Biol Eng Comput 2022; 60:2335-2348. [DOI: 10.1007/s11517-022-02601-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/07/2022] [Indexed: 12/01/2022]
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A case of successful slide tracheoplasty for long-segment congenital tracheal stenosis in a neonate with a congenital diaphragmatic hernia and Fallot's tetralogy. Surg Case Rep 2022; 8:66. [PMID: 35416626 PMCID: PMC9008082 DOI: 10.1186/s40792-022-01422-9] [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: 12/03/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Congenital tracheal stenosis (CTS) is a rare and life-threatening airway disorder, which is often associated with cardiac malformations. Among them, neonatal symptomatic CTS with cardiac malformations has an extremely poor prognosis. In contrast to cardiac malformation, congenital diaphragmatic hernia (CDH) has rarely been associated with CTS. We report a neonatal case in which slide tracheoplasty and intracardiac repair were performed simultaneously for CTS and Fallot’s tetralogy (TOF). Case presentation An infant with left CDH and Fallot's tetralogy (TOF) was born by cesarean section at 38 weeks of gestation. At the time of resuscitation, a 2.5 mm (ID) endotracheal tube could only be inserted just below the vocal cords. After repairing the CDH at 3 days of age, planned extubation was performed at 7 days of age. However, the patient required re-intubation due to life-threatening episodes after 2 days of the extubation. Enhanced CT revealed a long segment CTS from the upper trachea to the right bronchus (length of stenosis: 40 mm, minimum inner diameter: 2 mm). At 24 days of age, veno-arterial extracorporeal membrane oxygenation (ECMO) was introduced due to severe respiratory failure. At 28 days of age, slide tracheoplasty and palliative right ventricular outflow tract reconstruction (RVOTR) was performed with cardiopulmonary bypass (CPB). After tracheoplasty, a 3.5 mm tracheal (ID) tube could be placed in the reconstructed trachea in a patient with CTS. ECMO was completed 7 days after the operation. On the 17th day after the operation, he was extubated successfully. He was discharged 5 months after birth with home oxygenation therapy. Conclusions We reported the successful simultaneous correction of slide tracheoplasty and palliative RVOTR for a neonate with CDH. ECMO was used for respiratory management before and after surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s40792-022-01422-9.
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 61:1290-1297. [DOI: 10.1093/ejcts/ezac070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/30/2021] [Accepted: 01/25/2022] [Indexed: 11/14/2022] Open
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Tracheal development after left pulmonary artery reimplantation: an individual study. Sci Rep 2020; 10:17702. [PMID: 33077818 PMCID: PMC7572416 DOI: 10.1038/s41598-020-74890-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/06/2020] [Indexed: 11/21/2022] Open
Abstract
Pulmonary artery sling (PA sling) often presents as a life-threatening condition requiring urgent surgical correction. We reported 32 cases of PA sling in children who were followed up postoperatively in the past 6 years. All patients with PA slings who were admitted to the hospital from January 2012 to December 2017 and underwent surgery were retrospectively analyzed. The mean age of the 32 patients at repair was 16.97 months (range, 15 days to 128 months). Six patients required ventilator assistance for respiratory failure. All children underwent left pulmonary artery (LPA) reimplantation (n = 32), and 3 patients needed reimplantation slide tracheoplasty (n = 3) due to ventilation weaning failure. Four patients died, 27 patients survived until discharge, and 18 patients were followed up. Pulmonary computed tomography imaging and echocardiography were performed in 18 patients who were followed up. After LPA reimplantation, the tracheal carina area was significantly enlarged compared to that preoperation (p = 0.0002). In this follow-up cohort study, 75% of the patients who underwent LPA reimplantation survived until discharge. The survivors had subsequently well-developed pulmonary arteries and tracheas.
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Mandibular Distraction in Robin Sequence With Multi-Level Airway Disease: Always Contraindicated? J Craniofac Surg 2020; 31:1883-1887. [DOI: 10.1097/scs.0000000000006620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Wertz A, Fuller SM, Mascio C, Sobol SE, Jacobs IN, Javia L. Slide tracheoplasty: Predictors of outcomes and literature review. Int J Pediatr Otorhinolaryngol 2020; 130:109814. [PMID: 31862500 DOI: 10.1016/j.ijporl.2019.109814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Determine preoperative comorbidities and intraoperative parameters associated with adverse postoperative outcomes. METHODS Retrospective case series at a single tertiary care children's hospital from 2010 through 2017. RESULTS Twenty-six patients with median age of 6 months and median weight of 7.1 kg underwent slide tracheoplasty. Median time to extubation, length of intensive care unit admission, and length of hospitalization were 7, 27, and 30 days, respectively. Twenty-two (85%) required no additional intervention. Overall success was 87%. One (4%) patient required open revision, and 3 (11%) required tracheostomy. Concomitant cardiac surgery was associated with postoperative tracheostomy (p = 0.04). Age and weight at surgery were inversely correlated with length of intubation (p = 0.03) and length of hospital stay (p = 0.001, p = 0.002) respectively. Hospital stay was 2.2 times longer if preoperative mechanical ventilation was required (p = 0.01) and 39% longer for every 1 mm decrease in airway diameter at the narrowest portion of the stenosis (p = 0.005). There were no deaths related to persistent tracheal stenosis with a median follow-up of 24 months. CONCLUSION Slide tracheoplasty is safe and effective. Concomitant cardiac surgery was associated with postoperative tracheostomy. Lower age and weight at surgery were correlated with longer length of intubation and hospital stay. Preoperative mechanical ventilation and smaller airway diameter were associated with longer hospital stay. This information may be helpful in counseling families and planning future prospective studies.
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Affiliation(s)
- Aileen Wertz
- Division of Otolaryngology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Stephanie M Fuller
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Christopher Mascio
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Steven E Sobol
- Division of Otolaryngology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Ian N Jacobs
- Division of Otolaryngology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Luv Javia
- Division of Otolaryngology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Stephens EH, Eltayeb O, Mongé MC, Forbess JM, Rastatter JC, Rigsby CK, Backer CL. Pediatric Tracheal Surgery: A 25-Year Review of Slide Tracheoplasty and Tracheal Resection. Ann Thorac Surg 2020; 109:148-153. [DOI: 10.1016/j.athoracsur.2019.06.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/17/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
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Yong MS, Konstantinov IE. Understanding the impact of slide tracheoplasty in congenital tracheal stenosis. Transl Pediatr 2019; 8:462-464. [PMID: 31993362 PMCID: PMC6970118 DOI: 10.21037/tp.2019.11.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Matthew S Yong
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
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Abstract
A vascular ring is a rare congenital cardiovascular anomaly, which encircles and compresses the trachea or esophagus, or both. In this review we discuss the pathophysiology, theoretical embryopathogenesis, diagnostic modalities, and surgical treatment of the different types of vascular ring. Knowledge of the normal embryonic development of the aortic arch and related structures is important for understanding and classifying the various forms of vascular ring. The development of a vascular ring begins with the embryonic aortic arch system. The persistence, involution, or regression of the arches determines the multiple variations of vascular ring. With the development of new technologies, multi-detector computed tomography (MDCT) has become a good diagnostic modality for pre- and postoperative evaluation. MDCT provides an excellent image of aortic arch abnormalities and the related anatomy, as well as the tracheal pathology. For patients with symptoms, surgical division of the vascular ring usually achieves excellent outcomes with marked resolution of symptoms and a low risk of morbidity and mortality. Symptomatic vascular rings require early surgical intervention to prevent prolonged vascular compression of the airway and serious complications.
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Invited Commentary. Ann Thorac Surg 2019; 109:153-154. [PMID: 31454528 DOI: 10.1016/j.athoracsur.2019.06.099] [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: 06/23/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022]
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Long-term outcomes of patch tracheoplasty using collagenous tissue membranes (biosheets) produced by in-body tissue architecture in a beagle model. Surg Today 2019; 49:958-964. [PMID: 31098758 DOI: 10.1007/s00595-019-01818-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/18/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Although various artificial tracheas have been developed, none have proven satisfactory for clinical use. In-body tissue architecture (IBTA) has enabled us to produce collagenous tissues with a wide range of shapes and sizes to meet the needs of individual recipients. In the present study, we investigated the long-term outcomes of patch tracheoplasty using an IBTA-induced collagenous tissue membrane ("biosheet") in a beagle model. METHODS Nine adult female beagles were used. Biosheets were prepared by embedding cylindrical molds assembled with a silicone rod and a slitting pipe into dorsal subcutaneous pouches for 2 months. The sheets were then implanted by patch tracheoplasty. An endoscopic evaluation was performed after 1, 3, or 12 months. The implanted biosheets were harvested for a histological evaluation at the same time points. RESULTS All animals survived the study. At 1 month after tracheoplasty, the anastomotic parts and internal surface of the biosheets were smooth with ciliated columnar epithelium, which regenerated into the internal surface of the biosheet. The chronological spread of chondrocytes into the biosheet was observed at 3 and 12 months. CONCLUSIONS Biosheets showed excellent performance as a scaffold for trachea regeneration with complete luminal epithelium and partial chondrocytes in a 1-year beagle implantation model of patch tracheoplasty.
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Ramaswamy M, Anton-Martin P, Martinez LG, Muthialu N. Tailored Management of Airway Abnormalities in Children with Congenital Single Functional Lung. J Pediatr Surg 2019; 54:696-700. [PMID: 30528176 DOI: 10.1016/j.jpedsurg.2018.10.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 10/02/2018] [Accepted: 10/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Pediatric patients born with single functional lung can be associated with symptomatic airway abnormalities. Management of such patients is not only technically demanding but is also ethically challenging. This study reports our experience of managing symptomatic airway abnormalities in pediatric patients with congenital single functional lung. METHODS Observational retrospective cohort study performed at a tertiary children's hospital from January 2001 to September 2017. All children (0 to 18 years old) with congenital single functional lung (agenesis and hypoplasia) presenting with symptomatic airway abnormalities (long segment congenital tracheal stenosis and tracheomalacia) and requiring surgical interventions were included in the study. Children with single functional lung secondary to non-congenital causes were excluded. RESULTS A total of 16 patients with single functional lung (agenesis=8 and hypoplasia=8) and airway abnormalities (long segment congenital tracheal stenosis=12 and tracheomalacia =4) were eligible for the study. Lung abnormalities were common on the right side (n = 10, 62.5%). Associated abnormalities (cardiac and non-cardiac) were seen in 11 patients (68.8%). Surgical interventions for airway abnormalities, alone or in combination, included slide tracheoplasty (n=12), aortopexy with or without pericardiopexy (n=7), excision of rudimentary lung (n=4) and placement of intrathoracic tissue expanders to reposition the mediastinum (n=3). Nine patients (56.3%) underwent a one-stage repair while staged repairs (airway and cardiac) were performed in 7 (43.7%). Fourteen patients (87.5%) survived to hospital discharge. Of the survivors, 9 (64.2%) had stable airways not requiring respiratory support at home. CONCLUSION Management of pediatric patients with airway abnormalities in the setting of congenital single functional lung is feasible with acceptable surgical outcomes. This is facilitated by staged repairs and repositioning of mediastinum before a definitive airway repair in patients with significant comorbidities. Treatment should not be deferred to these patients if there are no obvious contraindications. TYPE OF STUDY Retrospective Case Control Study LEVEL OF EVIDENCE: Level III.
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Affiliation(s)
- Madhavan Ramaswamy
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Pilar Anton-Martin
- Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
| | - Laura Garcia Martinez
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK.
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Clinical outcomes after tracheoplasty in patients with congenital tracheal stenosis in 1997-2014. J Pediatr Surg 2018; 53:2140-2144. [PMID: 29370890 DOI: 10.1016/j.jpedsurg.2017.12.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/15/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mortality and morbidity of congenital tracheal stenosis (CTS) remain high. The aim of this study was to determine the factors predicting 12-month survival and 2-month successful extubation after tracheoplasty in patients with CTS. METHODS Retrospective chart reviews were conducted in patients with CTS undergoing tracheoplasty at a single institution between 1997 and 2014. Patients' characteristics at disease onset and tracheoplasty were summarized. Twelve-month survival rate and 2-month extubation rate without tracheotomy after tracheoplasty were analyzed. RESULTS We reviewed 81 patients' records. Multivariate analysis for 12-month survival revealed that older age (>2 months, hazard ratio [HR]: 0.08, 95% confidence interval [CI]: 0.02-0.36) or heavier body weight (>4.4 kg, HR: 0.13, 95% CI: 0.02-0.73) at tracheoplasty was a predictive factor for survival. Body weight at tracheoplasty (>8.2 kg, HR: 3.83, 95% CI: 1.88-7.79), preoperative balloon dilatation (HR: 0.30, 95% CI: 0.12-0.78), and carina involvement (HR: 0.36, 95% CI: 0.19-0.69) were predictive factors for successful extubation. CONCLUSIONS Although CTS management is individualized, age or body weight at tracheoplasty needs to be considered and assessed for survival, as well as preoperative balloon dilatation, and carina involvement for successful extubation. LEVELS OF EVIDENCE Level III.
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Yong MS, Harrison J, Berkowitz RG, Ranganathan S, Konstantinov IE. An approach to successful slide tracheoplasty in the low birth weight neonate with single lung. Int J Pediatr Otorhinolaryngol 2018; 108:80-81. [PMID: 29605371 DOI: 10.1016/j.ijporl.2018.02.026] [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: 12/22/2017] [Revised: 02/04/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022]
Abstract
The advent of the slide tracheoplasty technique and a multi-disciplinary approach has improved outcomes of congenital tracheal stenosis. However, tracheal surgery in younger patients with pulmonary malformations, especially low birth-weight neonates, has been associated with increased mortality. Patients with very low birth-weight, pulmonary malformations and prematurity may be palliated prior to definitive tracheal surgery due to the poor prognosis. We report a successful and unique approach of delaying tracheal reconstruction to allow growth and development in the premature, very low birth-weight neonate (1046g) with left lung agenesis.
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Affiliation(s)
- Matthew S Yong
- Department of Cardiothoracic Surgery, Royal Children's Hospital, Australia; University of Melbourne, Australia; Murdoch Children's Research Institute, Australia
| | - Joanne Harrison
- University of Melbourne, Australia; Murdoch Children's Research Institute, Australia; Department of Respiratory Medicine, Royal Children's Hospital, Australia
| | - Robert G Berkowitz
- University of Melbourne, Australia; Department of Otolaryngology, Royal Children's Hospital, Australia
| | - Sarath Ranganathan
- University of Melbourne, Australia; Murdoch Children's Research Institute, Australia; Department of Respiratory Medicine, Royal Children's Hospital, Australia
| | - Igor E Konstantinov
- Department of Cardiothoracic Surgery, Royal Children's Hospital, Australia; University of Melbourne, Australia; Murdoch Children's Research Institute, Australia.
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Abstract
PURPOSE Few reports have focused on the management of congenital tracheal stenosis (CTS) in the neonatal period. The aim of this study was to determine appropriate management strategies for CTS in the neonatal period. METHODS The medical records of eight neonatal patients with CTS at a single institution between January 2007 and December 2016 were retrospectively reviewed. RESULTS Three patients with frequent ventilatory insufficiency despite assisted ventilation underwent surgical intervention (balloon tracheoplasty: n = 1, slide tracheoplasty: n = 2). Ventilatory insufficiency improved after surgery in all three patients. One patient who underwent slide tracheoplasty died due to non-airway-related causes. Observation or conservative management was performed in five patients with minimal respiratory symptoms or stable ventilation under assisted ventilation. All five patients were safely managed non-operatively in the neonatal period. CONCLUSION Depending on the severity of ventilatory insufficiency, there are two management strategies for CTS in the neonatal period. Surgical intervention, such as balloon tracheoplasty or slide tracheoplasty, is indicated for patients with unstable ventilatory status despite assisted ventilation. Observation or conservative management is a more suitable option for neonates with stable ventilation.
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Zhang H, Wang S, Lu Z, Zhu L, Du X, Wang H, Xu Z. Slide tracheoplasty in 81 children: Improved outcomes with modified surgical technique and optimal surgical age. Medicine (Baltimore) 2017; 96:e8013. [PMID: 28930836 PMCID: PMC5617703 DOI: 10.1097/md.0000000000008013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the surgical outcome of slide tracheoplasty.Eighty-one patients who underwent slide tracheoplasty were retrospectively reviewed. Before and after operation, all patients were examined by computed tomography (CT) and bronchoscopy regularly.There were 8 deaths and the mortality was 9.9%. They all died of respiratory failure associated with the formation of granulation tissue in the airway postoperatively. The mortality was 15.8% from 2009 to 2012 and decreased to 8.1% from 2013 to 2016. The mortality of patients aged 10 to 24 months was 5.7%, which was significantly lower than those younger than 10 months and those older than 24 months. After surgery, 11 patients had granulation tissue growing at anastomosis edges and 8 of them died eventually. Twenty patients had mucosa varus at the site of anastomosis which mainly happened in the early time. Between different time periods and different age groups, there was significant difference in the incidence of granulation tissue and mucosa varus (P < .01). Clinical symptoms of tracheal stenosis disappeared and the results of CT were satisfactory after operation.Slide tracheoplasty is an effective surgical method for congenital tracheal stenosis associated with congenital heart disease. With the continuous improvement of surgical technique, the mortality has been reduced and the incidence of granulation tissue and mucosa varus also has been reduced. The period of 10 to 24 months of age is the optimal cure time.
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22
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Maughan EF, Butler CR, Crowley C, Teoh GZ, den Hondt M, Hamilton NJ, Hynds RE, Lange P, Ansari T, Urbani L, Janes SM, de Coppi P, Birchall MA, Elliott MJ. A comparison of tracheal scaffold strategies for pediatric transplantation in a rabbit model. Laryngoscope 2017; 127:E449-E457. [PMID: 28776693 DOI: 10.1002/lary.26611] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/15/2017] [Accepted: 03/08/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS Despite surgical advances, childhood tracheal stenosis is associated with high morbidity and mortality. Various tracheal scaffold strategies have been developed as the basis for bioengineered substitutes, but there is no consensus on which may be superior in vivo. We hypothesized that there would be no difference in morbidity and mortality between three competing scaffold strategies in rabbits. STUDY DESIGN Pilot preclinical study. METHODS Tracheal scaffolds were prepared by three methods that have been applied clinically and reported: preserved cadaveric ("Herberhold") allografts, detergent-enzymatically decellularized allografts, and synthetic scaffolds (nanocomposite polymer [polyhedral oligomeric silsesquioxane poly(carbonate-urea) urethane (POSS-PCU)]). Scaffolds were implanted into cervical trachea of New Zealand White rabbits (n = 4 per group) without cell seeding. Control animals (n = 4) received autotransplanted tracheal segments using the same technique. Animals underwent bronchoscopic monitoring of the grafts for 30 days. Macroscopic evaluation of tissue integration, graft stenosis, and collapsibility and histological examinations were performed on explants at termination. RESULTS All surgical controls survived to termination without airway compromise. Mild to moderate anastomotic stenosis from granulation tissue was detected, but there was evidence suggestive of vascular reconnection with minimal fibrous encapsulation. In contrast, three of the four animals in the Herberhold and POSS-PCU groups, and all animals receiving decellularized allografts, required early termination due to respiratory distress. Herberhold grafts showed intense inflammatory reactions, anastomotic stenoses, and mucus plugging. Synthetic graft integration and vascularization were poor, whereas decellularized grafts demonstrated malacia and collapse but had features suggestive of vascular connection or revascularization. CONCLUSIONS There are mirror-image benefits and drawbacks to nonrecellularized, decellularized, and synthetic grafts, such that none emerged as the preferred option. Results from prevascularized and/or cell-seeded grafts (as applied clinically) may elucidate clearer advantages of one scaffold type over another. LEVEL OF EVIDENCE NA. Laryngoscope, 127:E449-E457, 2017.
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Affiliation(s)
- Elizabeth F Maughan
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom.,Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Colin R Butler
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom.,Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Claire Crowley
- Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Gui Zhen Teoh
- Division of Surgery and Interventional Science, UCL Centre of Nanotechnology and Regenerative Medicine, University College London, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
| | - Margot den Hondt
- Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nicholas J Hamilton
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom.,UCL Ear Institute, Royal National Throat, Nose, and Ear Hospital, London, United Kingdom
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Peggy Lange
- Northwick Park Institute for Medical Research, Northwick Park, London, United Kingdom
| | - Tahera Ansari
- Northwick Park Institute for Medical Research, Northwick Park, London, United Kingdom
| | - Luca Urbani
- Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Samuel M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Paolo de Coppi
- Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Martin A Birchall
- UCL Ear Institute, Royal National Throat, Nose, and Ear Hospital, London, United Kingdom
| | - Martin J Elliott
- Department of Thoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, 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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DeMarcantonio MA, Hart CK, Yang CJ, Tabangin M, Rutter MJ, Bryant R, Manning PB, de Alarcón A. Slide tracheoplasty outcomes in children with congenital pulmonary malformations. Laryngoscope 2016; 127:1283-1287. [DOI: 10.1002/lary.26404] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/26/2016] [Accepted: 10/05/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Michael A. DeMarcantonio
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Catherine K. Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - Christina J. Yang
- Department of Otorhinolaryngology-Head and Neck Surgery; Montefiore Medical Center; Bronx New York U.S.A
| | - Meredith Tabangin
- Division of Biostatistics and Epidemiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Michael J. Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - Roosevelt Bryant
- The Heart Institute; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
- Department of Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - Peter B. Manning
- Division of Cardiothoracic Surgery; Washington University; St. Louis Missouri U.S.A
| | - Alessandro de Alarcón
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
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Hasegawa T, Oshima Y, Matsuhisa H, Okata Y, Yokoi A, Yokoyama S, Maeda K. Clinical equivalency of cardiopulmonary bypass and extracorporeal membrane oxygenation support for pediatric tracheal reconstruction. Pediatr Surg Int 2016; 32:1029-1036. [PMID: 27344586 DOI: 10.1007/s00383-016-3921-2] [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] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Pediatric surgery for congenital tracheal stenosis continues to be a therapeutic challenge, and it often requires cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) for intra-operative extracorporeal cardiorespiratory support. The purpose of this study was to compare the peri-operative outcomes of CPB with ECMO in pediatric tracheal reconstruction. METHODS Forty-three consecutive patients who underwent tracheal reconstruction without intra-cardiac repair for congenital tracheal stenosis at Kobe Children's Hospital between January 2000 and August 2012 were enrolled in this retrospective study. They were divided into two groups according to intra-operative extracorporeal cardiopulmonary support [CPB (n = 17) or ECMO (n = 26)]. Peri-operative variables were compared between the two groups. RESULTS The CPB and ECMO groups had similar patient and operative characteristics. However, the CPB group required larger priming volume and higher doses of total heparin injection. Although the ECMO group exhibited less peri-operative bleeding and lower red blood cell requirement, there were no statistically significant differences between the two groups. Compared to the ECMO group, patients in the CPB group had significantly less positive fluid balance during surgery and in the first 24 h after surgery, and exhibited a trend towards higher ratios of PO2 to the fraction of inspired oxygen and lower PCO2 at the time of ICU admission and on post-operative day 1. CONCLUSIONS Pediatric tracheal reconstruction should be performed with intra-operative CPB or ECMO, after considering the advantages of utilizing each extracorporeal cardiorespiratory support type according to the patient's specific condition and situation.
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Affiliation(s)
- Tomomi Hasegawa
- Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan. .,Department of Cardiovascular Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
| | - Yoshihiro Oshima
- Department of Cardiovascular Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Hironori Matsuhisa
- Department of Cardiovascular Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Yuichi Okata
- Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Akiko Yokoi
- Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Shinji Yokoyama
- Department of Cardiovascular Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Kosaku Maeda
- Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
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26
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Yazdanbakhsh AP, van Rijssen LB, Koolbergen DR, König A, de Mol BAJM, Hazekamp MG. Long-term follow-up of tracheoplasty using autologous pericardial patch and strips of costal cartilage. Eur J Cardiothorac Surg 2014; 47:146-52; discussion 152. [PMID: 24648427 DOI: 10.1093/ejcts/ezu101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate long-term results of tracheoplasty using autologous pericardial patch and strips of costal cartilage for relieving severe long-segment tracheal stenosis. METHODS Data were collected retrospectively by clinical chart review. Between 1995 and 2013, 21 patients underwent tracheoplasty. Follow-up was performed by outpatient chart review; otherwise, referring physicians and parents were contacted and asked to fill in a questionnaire. RESULTS Median age at the time of operation was 0.9 (range 0.5-44) years. Aetiology of tracheal stenosis was double aortic arch in 9 patients, right arch with a left ductus in 3, innominate artery compression in 1 patient, complete tracheal rings in 7, 3 of whom with pulmonary artery sling and 2 with agenesis of one lung, and other causes in 1 patient. Previous surgery was performed in 6 (29%) patients. Patch tracheoplasty was performed using autologous pericardial patch and external stenting using costal cartilage. Major complications were mediastinitis and patch dehiscence in 2 patients, 2 patients needed tracheal cannula and 1 patient had stent implantation. Three (14%) patients died in the late postoperative period: 1 patient died of sepsis, 1 had patch dehiscence and 1 erosion of tracheal stent and consequently intractable bleeding. Follow-up was 6.1±2.7 years (0.75-10 years). At follow-up, 2 (11%) patients were still symptomatic, 4 (22%) had occasionally mild symptoms and 12 (67%) were free of symptoms. CONCLUSIONS Treatment for severe tracheal stenosis remains challenging. With tracheoplasty using autologous pericardial patch and strips of costal cartilage, long and narrow tracheal stenosis can be repaired. There are no limitations as to the length and location and severity of the stenosis. Tracheoplasty is associated with a high complication rate. A multidisciplinary approach is mandatory to ensure favourable long-term outcomes.
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Affiliation(s)
- Aria P Yazdanbakhsh
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands Leiden University Medical Center, Leiden, Netherlands
| | - Lennart B van Rijssen
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands Leiden University Medical Center, Leiden, Netherlands
| | - David R Koolbergen
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands Leiden University Medical Center, Leiden, Netherlands
| | - Astrid König
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bas A J M de Mol
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands Leiden University Medical Center, Leiden, Netherlands
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27
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Hasegawa T, Oshima Y, Maruo A, Matsuhisa H, Yokoi A, Okata Y, Nishijima E, Yamaguchi M. Pediatric cardiothoracic surgery in patients with unilateral pulmonary agenesis or aplasia. Ann Thorac Surg 2014; 97:1652-8. [PMID: 24507772 DOI: 10.1016/j.athoracsur.2013.11.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 11/03/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Unilateral pulmonary agenesis or aplasia (UPA), a rare developmental defect of the lung, is sometimes associated with congenital heart and tracheal diseases. The purpose of this study was to assess our experience of pediatric cardiothoracic surgery in UPA patients. METHODS Cardiothoracic surgery for congenital heart defect or tracheal stenosis performed between 1981 and 2010 in 8 UPA patients (agenesis in 5 and aplasia in 3) was reviewed retrospectively. Associated cardiac anomalies included ventricular septal defect, double outlet right ventricle with pulmonary atresia, total anomalous pulmonary venous connection, and interrupted aortic arch complex. RESULTS For 7 patients with right UPA and 1 patient with left UPA, 12 cardiothoracic operations were performed, including 8 cardiac procedures in 4 patients and 4 tracheal procedures in 4 patients. Cardiac palliative repairs included Blalock-Park anastomosis, systemic-to-pulmonary artery shunt, and pulmonary artery banding. Cardiac definitive repairs included ventricular septal defect closure, subaortic membrane resection, modified Konno procedure, total anomalous pulmonary venous connection repair, and Rastelli-type operation. Tracheal repairs were costal cartilage tracheoplasty and slide tracheoplasty. The median age at surgery was 8 months and median body weight was 6.2 kg; the median operative time was 6.5 hours. There were 3 hospital deaths and 1 late death, with the 1-year mortality rate of 25%. Cardiopulmonary bypass-induced acute lung injury has occurred in 3 cases, 2 of which required extracorporeal membrane oxygenation support. Younger age of less than 1 month and prolonged cardiopulmonary bypass time of more than 200 minutes were related to operative risk factors for hospital mortality and morbidity. CONCLUSIONS Most of the pediatric cardiothoracic operations in UPA patients were successfully performed through an optimal surgical approach and procedure, but they still presented surgical risks of high mortality and morbidity. Perioperative management of UPA patients should be provided with a precise understanding of anatomic configuration and a careful consideration of underlying risk factors.
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Affiliation(s)
- Tomomi Hasegawa
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Hyogo, Japan.
| | - Yoshihiro Oshima
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Ayako Maruo
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Hironori Matsuhisa
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Yuichi Okata
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Eiji Nishijima
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Masahiro Yamaguchi
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Hyogo, Japan
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Komura M, Komura H, Konishi K, Ishimaru T, Hoshi K, Takato T, Tabata Y, Iwanaka T. Promotion of tracheal cartilage growth by intra-tracheal injection of basic fibroblast growth factor (b-FGF). J Pediatr Surg 2014; 49:296-300. [PMID: 24528971 DOI: 10.1016/j.jpedsurg.2013.11.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/10/2013] [Indexed: 01/03/2023]
Abstract
PURPOSE Basic fibroblast growth factor (b-FGF) is a very effective growth factor that induces the proliferation of chondrocytes. This study aimed to investigate whether intra-tracheally-injected b-FGF solution promotes the growth of tracheal cartilage. METHODS Group 1: 500 μl of distilled water was injected at the posterior wall of the cervical trachea of New Zealand white rabbits by using a tracheoscope (n=5). Group 2: 100 μg/500 μl of b-FGF solution was injected at the posterior wall of the cervical trachea (n=5). Group 3: Biodegradable gelatin hydrogel microspheres incorporating 100 μg/500 μl of b-FGF solution were injected at the posterior wall of the cervical trachea (n=5). All animals were sacrificed 4 weeks later, and the outer diameter and luminal area of the cervical trachea at the site of b-FGF injection were measured. RESULTS The cervical tracheas in the two b-FGF injection groups were spindle-shaped and had a maximum diameter at the injection site. The median outer diameter of the cervical trachea in Groups 1, 2, and 3 was 7.3, 8.0, and 8.0mm, respectively, showing a significant difference among Groups 1, 2, and 3 (P=0.04). The median luminal area in Groups 1, 2, and 3 was 27.4, 29.4, and 32.1mm(2), respectively. The ad hoc test showed a marginally significant difference only between groups 1 and 3 (p=0.056). CONCLUSION Intra-tracheal injection of slowly released b-FGF enlarged the tracheal lumen.
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Affiliation(s)
- Makoto Komura
- Dept. of Pediatric Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655; Dept. of Pediatric Surgery, Graduate School of Medicine, Saitama Medical University, 38 Morohongo, Moroyamacho, Irumagun, Saitama prefecture 350-0495.
| | - Hiroko Komura
- Dept. of Pediatric Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655
| | - Kenichirou Konishi
- Dept. of Pediatric Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655
| | - Tetsuya Ishimaru
- Dept. of Pediatric Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655
| | - Kazuto Hoshi
- Dept. of Tissue Engineering, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655
| | - Tsuyoshi Takato
- Dept. of Tissue Engineering, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655
| | - Yasuhiko Tabata
- Dept. of Biomaterials, Field of Tissue Engineering, Institute of Frontier Medical Science, Kyoto University, 53 Shogoin Kawara cho, Sakyo-ku, Kyoto prefecture, 606-8507
| | - Tadashi Iwanaka
- Dept. of Pediatric Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655
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Yokoi A, Nakao M, Bitoh Y, Arai H, Oshima Y, Nishijima E. Treatment of postoperative tracheal granulation tissue with inhaled budesonide in congenital tracheal stenosis. J Pediatr Surg 2014; 49:293-5; discussion 295. [PMID: 24528970 DOI: 10.1016/j.jpedsurg.2013.11.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/10/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Tracheal obstruction by granulation tissue can compromise the postoperative course in congenital tracheal stenosis (CTS). Balloon dilatation and stenting may be required. Budesonide is a corticosteroid with topical anti-inflammatory effects. In 2008, we used inhaled budesonide for treatment of postoperative granulation tissue for the first time in CTS, resulting in significant improvement. The aim of this study was to evaluate the efficacy of inhaled budesonide for treatment of postoperative granulation tissue in CTS. METHODS Retrospective chart review was conducted. From 2004 through 2011, we performed 39 tracheoplasties. Forced stenting ± balloon dilatation (S/B) was required when airway obstruction with tissue granulation was life-threatening. We compared the requirement for S/B between the early group without budesonide (2004-Nov. 2008, Early) and the late group with budesonide (Dec. 2008-2011, Late). Statistical analysis was performed using Fisher's Exact test. RESULTS Eleven of 22 in Early and 8 of 17 in Late were successfully extubated, never having had life-threatening tissue granulation. The remaining patients in each group (11 in Early and 9 in Late) required tracheostomies due to postoperative complication. Ten in Early and 5 in Late with tracheostomies developed granulation tissue. Of these patients, the 10 in Early required S/B, while none of the 5 in Late required S/B (P=.0003). Bronchoscopy demonstrated significant regression of granulation tissue in all cases treated with inhaled budesonide. CONCLUSION Inhaled budesonide is effective for treatment of tracheal granulation tissue in patients with tracheostomies after repair of CTS.
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Affiliation(s)
- Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan.
| | - Makoto Nakao
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Yuko Bitoh
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Hiroshi Arai
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Yoshihiro Oshima
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Eiji Nishijima
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
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Anton-Pacheco JL, Comas JV, Luna C, Benavent MI, Lopez M, Ramos V, Mendez MD. Treatment strategies in the management of severe complications following slide tracheoplasty in children. Eur J Cardiothorac Surg 2014; 46:280-5; discussion 285. [DOI: 10.1093/ejcts/ezt617] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hasegawa T, Oshima Y, Hisamatsu C, Matsuhisa H, Maruo A, Yokoi A, Bitoh Y, Nishijima E, Okita Y. Innominate artery compression of the trachea in patients with neurological or neuromuscular disorders. Eur J Cardiothorac Surg 2013; 45:305-11. [DOI: 10.1093/ejcts/ezt346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yong MS, d'Udekem Y, Robertson CF, Butt W, Brizard CP, Konstantinov IE. Tracheal repair in children: reduction of mortality with advent of slide tracheoplasty. ANZ J Surg 2013; 84:748-54. [DOI: 10.1111/ans.12132] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Matthew S. Yong
- Department of Cardiothoracic Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Yves d'Udekem
- Department of Cardiothoracic Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Colin F. Robertson
- Department of Respiratory Medicine; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Warwick Butt
- Department of Intensive Care; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Christian P. Brizard
- Department of Cardiothoracic Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Igor E. Konstantinov
- Department of Cardiothoracic Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
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Slow release of basic fibroblast growth factor (b-FGF) promotes growth of tracheal cartilage. J Pediatr Surg 2013; 48:288-92. [PMID: 23414853 DOI: 10.1016/j.jpedsurg.2012.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 11/12/2012] [Indexed: 01/08/2023]
Abstract
PURPOSE Tracheomalacia is a major cause of morbidity in conditions such as oesophageal atresia. However, symptoms usually improve with age. A more rapid growth of tracheal cartilage can be induced by basic-Fibroblast Growth Factor (b-FGF). This study aimed to investigate whether slow-release b-FGF could act as a novel treatment for tracheomalacia. METHODS Biodegradable gelatin hydrogel sheets incorporating 0.5, 5, or 50 μg/20 μl of b-FGF solution were inserted between the cervical trachea and esophagus of rats. No intervention was performed in rats in a control group. All animals were sacrificed 4 weeks later, and the luminal area of the cervical trachea and the thickness of the cartilage were measured. RESULTS The mean luminal areas in the control group and in the b-FGF groups were 3.1, 3.2, 3.8, and 2.6mm(2), respectively, and showed a peak area at 5 μg of b-FGF. A significant difference was seen only between the control group and the b-FGF 5 μg group (p<0.05). The mean thickness of the tracheal cartilage was 0.12, 0.13, 0.19, and 0.32 mm in the control and the b-FGF groups, respectively, and showed a dose-dependent increase, which was statistically significant between the b-FGF 5 μg or 50 μg groups and the control group (p<0.01). CONCLUSION This study showed that slow-release b-FGF enlarges the tracheal lumen and thickens the cartilage in a dose-dependent fashion.
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Coticchia JM, Cohen D, Sachdeva L. Grand challenges in pediatric otolaryngology. Front Pediatr 2013; 1:10. [PMID: 24400256 PMCID: PMC3860887 DOI: 10.3389/fped.2013.00010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/01/2013] [Indexed: 11/18/2022] Open
Affiliation(s)
- James M Coticchia
- Division of Pediatric Otolaryngology, Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Wayne State University Detroit, MI, USA
| | - David Cohen
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Wayne State University Detroit, MI, USA
| | - Livjot Sachdeva
- Division of Pediatric Otolaryngology, Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Wayne State University Detroit, MI, USA
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Kacmarynski DSF, Amendola R, Reinhardt JM, Smith RJH. Flexible models for planning repair of complex tracheal anomalies. Laryngoscope 2012; 122 Suppl 4:S77. [DOI: 10.1002/lary.23802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2012] [Indexed: 11/09/2022]
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Successful tracheobronchial reconstruction of communicating bronchopulmonary foregut malformation and long segment congenital tracheal stenosis: a case report. J Pediatr Surg 2012; 47:E41-6. [PMID: 22974635 DOI: 10.1016/j.jpedsurg.2012.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/22/2012] [Accepted: 06/13/2012] [Indexed: 11/22/2022]
Abstract
Communicating bronchopulmonary foregut malformation (CBPFM) and congenital tracheal stenosis (CTS) are difficult developmental disorders especially when they are presented simultaneously in a patient. The authors report a case of a newborn boy born at 37 weeks of gestation weighing 2356 g with CBPFM (right esophageal lung) and long segment CTS. Staged surgical repair (by-force endotracheal intubation for securing the airway followed by bronchotracheal anastomosis for CBPFM, tracheostomy with handmade, length-adjustable tracheostomy tube, and slide tracheoplasty) was performed. He has been healthy without tracheostomy for 25 months after slide tracheoplasty. This is the first report of a successful tracheobronchial reconstruction for a patient with a long segment CTS and CBPFM preserving the affected lung function.
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Yong MS, d'Udekem Y, Brizard CP, Robertson T, Robertson CF, Weintraub R, Konstantinov IE. Surgical management of pulmonary artery sling in children. J Thorac Cardiovasc Surg 2012; 145:1033-1039. [PMID: 22698556 DOI: 10.1016/j.jtcvs.2012.05.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 04/12/2012] [Accepted: 05/09/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Pulmonary artery (PA) sling is a rare vascular anomaly associated with congenital tracheal stenosis. The natural history is poor and these patients often require early surgical intervention. We describe our experience with repair of this condition. METHODS From 1984 to 2011, 21 patients with PA sling underwent repair at the Royal Children's Hospital (median age, 5.9 months). PA sling was associated with compression of the trachea in all patients. Tracheal surgery was required in 12 (57.1%) patients. All patients had an echocardiogram, and concomitant repair of coexisting cardiac anomalies was performed in 6 (28.6%, 6/21) patients. RESULTS Operative mortality was 14.3% (3/21), occurring at 19 days, 4.4 months, and 5 months after surgery. Operative mortality for the first 10 years was 22.2% (1984-1993; 2/9), the next 10 years was 14.3% (1994-2003; 1/7), and 0% for the most recent 7 years (2004-2011; 0/5). All deaths occurred in patients requiring tracheal repair (25%, 3/12). No deaths have occurred since 2004 with introduction of the slide tracheoplasty technique. One (5.6%, 1/18) late death occurred at 8 months after repair. After tracheal repair, intervention for excessive granulations and tracheomalacia was necessary in 6 (50%, 6/12) patients. Median follow-up was 8 years (mean, 8.6 ± 6.4 years; range, 5 months to 20.6 years), and all survivors (100%, 17/17) remain asymptomatic. CONCLUSIONS Children with PA sling who do not require tracheal surgery have excellent outcomes. Mortality is determined by the need for tracheal surgery. However, with the advent of the slide tracheoplasty technique, mortality can be reduced. Survival beyond 1 year after surgery offers excellent prognosis.
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Affiliation(s)
- Matthew S Yong
- Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Christian P Brizard
- Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Colin F Robertson
- Royal Children's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Robert Weintraub
- Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
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Yokoi A, Arai H, Bitoh Y, Nakao M, Oshima Y, Nishijima E. Aortopexy with tracheal reconstruction for postoperative tracheomalacia in congenital tracheal stenosis. J Pediatr Surg 2012; 47:1080-3. [PMID: 22703773 DOI: 10.1016/j.jpedsurg.2012.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Congenital tracheal stenosis is a rare condition and can be difficult to manage. One source of difficulty is postoperative tracheomalacia requiring long-term tracheal stenting. To prevent symptomatic postoperative tracheomalacia, we have been adding aortopexy to tracheal reconstruction since 2008. The aim of this study was to evaluate efficacy of aortopexy for preventing postoperative tracheomalacia after reconstruction of congenital tracheal stenosis. METHODS Retrospective chart review was conducted. From October 2003 to March 2011, 24 had tracheal reconstruction without aortopexy (group A) and 8 with aortopexy (group B). Statistical analysis was performed using Fisher's Exact test. RESULTS One had anastomotic leakage in group A, and 1, in group B (P = .44). Eleven patients required tracheostomy because of postoperative tracheomalacia confirmed by postoperative bronchoscopy in group A vs none in group B (P = .029). CONCLUSIONS We found that aortopexy with tracheal reconstruction reduced the need for postoperative tracheostomy in this patient group. Although there is a potential risk of anastomotic leakage because of the suspension suture on the anterior tracheal wall to aorta, we did not detect an increased incidence after aortopexy. Thus, aortic suspension may be a useful adjunct to prevent symptoms of tracheomalacia in these patients.
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Affiliation(s)
- Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe 654-0081, Japan.
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Abstract
PURPOSE Slide tracheoplasty for congenital tracheal stenosis was reported by Tsang. This procedure provides good results, but there are few studies about the tracheal growth of post-surgical condition. Recently, not only traditional posterior to anterior slide plasty but also right side to left side slide plasty was reported. We evaluated the tracheal growth after slide tracheoplasty in growing Japanese white rabbit model. METHODS The Japanese white rabbits, weighing 1,600-2,400 g, were used for this study. One-third of the estimated length of the trachea was slantingly resected about an appropriate angle. We performed a slant, side-to-side tracheal anastomosis in two ways (slanted from the front to the back in four animals, and slanted from right to left in four animals) on growing rabbits as an animal model of slide tracheoplasty. RESULTS All the rabbits were alive until the 10th week after surgery. There was no evidence of differential growth in any part of the circumference of the normal and anastomotic tracheas. Histologically, all tracheal lumina were completely lined with normal respiratory epithelium and normal surrounding cartilage. CONCLUSION The results presented that these two methods did not prevent the tracheal growth and trachea did not buckle macroscopically. Both slide tracheoplasties did not interrupt the growth of trachea.
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Affiliation(s)
- Yoichi Takano
- Department of Pediatric Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan ,Division of Pediatric Surgery, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Kosaku Maeda
- Division of Pediatric Surgery, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Chieko Hisamatsu
- Department of Pediatric Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Eiji Nishijima
- Department of Pediatric Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
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Valencia D, Overman D, Tibesar R, Lander T, Moga F, Sidman J. Surgical management of distal tracheal stenosis in children. Laryngoscope 2011; 121:2665-71. [DOI: 10.1002/lary.22355] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Surgical outcome of slide tracheoplasty in patients with long congenital segment tracheal stenosis and single lung. Eur J Cardiothorac Surg 2011; 39:e170-4. [DOI: 10.1016/j.ejcts.2011.01.075] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 01/25/2011] [Accepted: 01/31/2011] [Indexed: 11/23/2022] Open
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[Surgical treatment of anomalous left pulmonary artery]. Rev Esp Cardiol 2011; 64:338-41. [PMID: 21377261 DOI: 10.1016/j.recesp.2010.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 06/03/2010] [Indexed: 11/24/2022]
Abstract
We report our experience with the surgical treatment of anomalous origin of the left pulmonary artery in eight children between 2004 and 2009. The congenital heart disease most frequently associated with this condition was patent ductus arteriosus. Surgery was carried out with extracorporeal circulation in five children, and without, in three. The anomalous pulmonary artery was divided and translocated to the main pulmonary artery. One patient died soon after surgery because of hemodynamic instability and another died later because of respiratory complications. The other patients progressed satisfactorily during follow-up: the reimplanted artery remained patent in all cases and respiratory symptoms improved. However, one patient required endoscopic treatment.
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Manning PB, Rutter MJ, Lisec A, Gupta R, Marino BS. One slide fits all: The versatility of slide tracheoplasty with cardiopulmonary bypass support for airway reconstruction in children. J Thorac Cardiovasc Surg 2011; 141:155-61. [DOI: 10.1016/j.jtcvs.2010.08.060] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 08/07/2010] [Accepted: 08/29/2010] [Indexed: 11/15/2022]
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Martinod E, Seguin A, Radu D, Marquette CH, Carpentier A. Avancées en chirurgie trachéale : a-t-on enfin trouvé le substitut idéal à la trachée ? Rev Mal Respir 2010; 27:554-64. [DOI: 10.1016/j.rmr.2010.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 12/21/2009] [Indexed: 12/16/2022]
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Toma M, Kamagata S, Hirobe S, Komori K, Okumura K, Mutoh M, Hayashi A. Modified slide tracheoplasty for congenital tracheal stenosis. J Pediatr Surg 2009; 44:2019-22. [PMID: 19853766 DOI: 10.1016/j.jpedsurg.2009.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 06/08/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
Abstract
Slide tracheoplasty has become a standard procedure to treat long-segment congenital tracheal stenosis because it is a reasonable and simple technique. Slide tracheoplasty does not affect the carina during long-segment congenital tracheal stenosis management, and thus lesions of the carina, such as stenosis and tracheobronchomalacia can become important causes of extubation failure after surgery. In this manusript, we describe the effectiveness of our modified slide tracheoplasty, which includes reconstruction of the carina. We have performed this technique on three patients, all of whom were extubated without developing any respiratory symptoms.
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Affiliation(s)
- Miki Toma
- Department of Surgery, Tokyo Metropolitan Kiyose Children's Hospital, Kiyose City, Tokyo, Japan.
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Backer CL, Kelle AM, Mavroudis C, Rigsby CK, Kaushal S, Holinger LD. Tracheal Reconstruction in Children With Unilateral Lung Agenesis or Severe Hypoplasia. Ann Thorac Surg 2009; 88:624-30; discussion 630-1. [DOI: 10.1016/j.athoracsur.2009.04.111] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Revised: 04/21/2009] [Accepted: 04/24/2009] [Indexed: 11/26/2022]
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Terra RM, Minamoto H, Mariano LCB, Fernandez A, Otoch JP, Jatene FB. Surgical treatment of congenital tracheal stenoses. J Bras Pneumol 2009; 35:515-20. [PMID: 19618031 DOI: 10.1590/s1806-37132009000600004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 12/09/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the outcomes of patients undergoing repair of congenital tracheal stenosis. METHODS This was a retrospective review of congenital tracheal stenosis patients treated between 2001 and 2007 at the University of São Paulo School of Medicine Hospital das Clínicas in São Paulo, Brazil. RESULTS Six boys and one girl (age at diagnosis ranging from 28 days to 3 years) were included. Five of the patients also had cardiac or major vessel malformations. The stenosis length was short in three patients, medium in one and long in three. The techniques used were pericardial patch tracheoplasty in three patients, resection and anastomosis in two, slide tracheoplasty in one and vascular ring correction in one. One patient died during surgery due to hypoxia and hemodynamic instability, and one died from septic shock on postoperative day 11. Other complications included pneumonia, arrhythmia, stenosis at the anastomosis level, residual stenosis, granuloma formation and malacia. The mean follow-up period was 31 months; four patients were cured, and one required the use of a T tube to maintain airway patency. CONCLUSIONS Congenital tracheal stenosis is a curable disease. However, its repair is complex and is associated with high rates of morbidity and mortality.
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Affiliation(s)
- Ricardo Mingarini Terra
- Department of Thoracic Surgery, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
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Terada M, Hotoda K, Toma M, Hirobe S, Kamagata S. Surgical management of congenital tracheal stenosis. Gen Thorac Cardiovasc Surg 2009; 57:175-83. [DOI: 10.1007/s11748-008-0399-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Indexed: 11/28/2022]
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Okamoto T, Nishijima E, Maruo A, Yokoi A, Takamizawa S, Satoh S, Oshima Y. Congenital tracheal stenosis: the prognostic significance of associated cardiovascular anomalies and the optimal timing of surgical treatment. J Pediatr Surg 2009; 44:325-8. [PMID: 19231527 DOI: 10.1016/j.jpedsurg.2008.10.080] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 10/23/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE Cardiovascular anomalies (CA) are frequently associated with congenital tracheal stenosis (CTS), but their prognostic impact on CTS and the optimal timing of surgical treatment remain uncertain. The aim of this study was to explore the prognostic factors and the optimal timing of surgical treatment in CTS patients with CA. METHODS After obtaining institutional review board approval, a retrospective review of 42 patients who underwent surgical repair of CTS between 1996 and 2006 was conducted. The patients were divided into 3 groups: CTS without CA (n = 10, group A), CTS with CA repaired simultaneously (n = 27, group B), and CTS with CA repaired in stages (n = 5, group C). Seven clinical characteristics, including gestational week and weight at birth, the age and body weight at operation, the length of tracheal stenosis (%), the duration of cardiopulmonary bypass (CPB) during surgery, and operation time were compared among the groups using analysis of variance, Fisher's Exact test, and Student's t test. RESULTS Although no operative mortalities occurred in groups A and C, there were 3 early deaths and 1 late death in group B. The deaths occurred in cases with associated complex CA (critical pulmonary stenosis, tetralogy of Fallot with an absent pulmonary valve, right ventricular outflow block, and cor triatrium). The duration of CPB was significantly different between groups A and B (P = .017), and furthermore, CPB time was significantly longer in early death cases than in surviving cases in group B (318.3 +/- .71.1 vs 204.0 +/- 67.8 minutes; P = .012). CONCLUSIONS Complex CA and long CPB duration would be prognostic factors for the outcome of surgical management for CTS and CA. Simultaneous reconstruction of CTS and simple CA appears to be a reasonable method of surgical intervention, but patients with long segment CTS with complex CA may still be difficult to cure using this strategy, and staged correction may be considered.
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Affiliation(s)
- Tatsuya Okamoto
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
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50
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Oshima Y, Yamaguchi M, Yoshimura N, Sato S, Muraji T, Nishijima E, Tsugawa C. Management of Pulmonary Artery Sling Associated With Tracheal Stenosis. Ann Thorac Surg 2008; 86:1334-8. [DOI: 10.1016/j.athoracsur.2008.04.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 04/04/2008] [Accepted: 04/07/2008] [Indexed: 11/15/2022]
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