1
|
Maltezeanu A, Aldriweesh B, Chan CY, Fayoux P, Bernier PL, Daniela da Silva S, Daniel SJ. Slide tracheoplasty for congenital tracheal stenosis: A systematic review. Int J Pediatr Otorhinolaryngol 2024; 182:111993. [PMID: 38885545 DOI: 10.1016/j.ijporl.2024.111993] [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: 11/20/2023] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Slide tracheoplasty has become the gold standard surgery for congenital tracheal stenosis (CTS). This condition is rare and the surgery can be challenging and is performed by experienced surgeons in tertiary centers. A few reports involving relatively small cohorts have been published. The aim of this review is to evaluate the post-operative mortality and morbidity of pediatric slide tracheoplasty for CTS. METHODS A systematic literature review was performed according to PRISMA guidelines. The Medline and EMBASE databases were screened using a search strategy defined in collaboration with a librarian. We included articles reporting the post-operative mortality rate of slide tracheoplasties for treatment of CTS in children, when at least 10 patients were included. RESULTS A total of 932 articles were reviewed, and 15 studies were eligible with a total of 845 patients. The overall post-operative mortality rate was 9.3 %, and most deaths were airway related. The open revision surgery rate after surgery was 2.8 % and the endoscopic revision rate was 27.6 %. DISCUSSION This study highlights key factors to consider before the surgery and helps anticipate post-operative follow-up considerations for children with CTS. Several factors were identified as predictors of mortality including young age, weight at the time of surgery and association with lung hypoplasia or aplasia. CONCLUSION Although slide tracheoplasty has gained popularity in recent years due to better outcomes, it remains a major surgery with mortality risk and the need for multidisciplinary management.
Collapse
Affiliation(s)
- Alix Maltezeanu
- Division of Otolaryngology-Head and Neck Surgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Department of Pediatric Otolaryngology, Faculty of Medicine - Jeanne de Flandre Hospital, Lille, France
| | - Bshair Aldriweesh
- Division of Otolaryngology-Head and Neck Surgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Department of Otolaryngology-Head & Neck Surgery, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Ching Yee Chan
- Division of Otolaryngology-Head and Neck Surgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Department of Otolaryngology, KK Women's and Children's Hospital, Singapore
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology, Faculty of Medicine - Jeanne de Flandre Hospital, Lille, France
| | - Pierre-Luc Bernier
- Department of Pediatric Cardiothoracic Surgery, Faculty of Medicine - McGill University, Montreal, QC, Canada
| | - Sabrina Daniela da Silva
- Division of Otolaryngology-Head and Neck Surgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Sam J Daniel
- Division of Otolaryngology-Head and Neck Surgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Shi X, Wang C, Hua Y, Liu X, Duan H. A Delayed Anatomic Diagnosis and Management Challenge in an Initially Asymptomatic Infant With Type II Pulmonary Artery Sling: A Case Report. Front Cardiovasc Med 2021; 8:743848. [PMID: 34746260 PMCID: PMC8566341 DOI: 10.3389/fcvm.2021.743848] [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: 07/19/2021] [Accepted: 09/21/2021] [Indexed: 12/04/2022] Open
Abstract
Pulmonary artery sling (PAS) is a rare but fatal malformation. Patients with PAS tend to develop obstructive symptoms in few weeks of life. Conversely, some patients may be otherwise mild or asymptomatic in their early life. Currently, no consensus on the intervention timing and treatment strategy for asymptomatic and mild cases has been reached. Moreover, the extent of tracheal stenosis is another determining factor for the choice of intervention timing since clinical symptoms might not correspond well with the degree of stenosis. Lack of comprehensive assessment of entire airways confer underestimation of disease severity and in turn improper choice of treatment regimens and poor outcomes. Herein, we described an infantile case of PAS, who was scheduled initially for periodic outpatient follow-up on account of the absence of symptoms and inadequate imaging assessment at diagnosis. The patient developed recurrent wheezing and progressive respiratory distress at 7 months of age. After left pulmonary artery (LPA) reimplantation without tracheal intervention, bronchoscopy was performed due to failure to wean from mechanical ventilation, which demonstrated complete tracheal cartilage rings, a long segment tracheal stenosis, a low tracheal bifurcation at T6, and the absence of a separate right middle lobe bronchus. The patient was finally diagnosed with type IIb PAS and extubated successfully following conservative treatment. Miserably, neurological sequelae were devastating, leading to poor outcomes. Comprehensive airway evaluation using bronchoscopy is substantial to early identification of all components responsible for airway compromise in PAS anatomic subtypes. Considering severe concomitant maldevelopment of the bronchial tree in children with type IIb PAS, early and complete correction by surgery might decrease perioperative morbidities and mortalities of these patients.
Collapse
Affiliation(s)
- Xiaoqing Shi
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chuan Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yimin Hua
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.,Key Laboratory of Development and Diseases of Women and Children of Sichuan, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaoliang Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hongyu Duan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
5
|
Li S, Wu L, Huang M, Zhou J, Wang Y, Chen Z. Cardiopulmonary bypass as a bridge for bronchial foreign body removal in a child with pulmonary artery sling: A case report. Medicine (Baltimore) 2021; 100:e26908. [PMID: 34397925 PMCID: PMC8360435 DOI: 10.1097/md.0000000000026908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/26/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Successful removal of an airway foreign body (FB) in some intractable cases can be very challenging, because of tracheal anomalies, unstable respiratory status of the patients, and the location of FB. The use of cardiopulmonary bypass (CPB) support for the treatment of a FB is extremely rare. PATIENT CONCERNS We present a case of a 39-month-old previously healthy girl who was admitted to our hospital for suspected FB aspiration (FBA). Initially, the attempt for removal of the FB by conventional bronchoscopy failed because of hypoxic intolerance. DIAGNOSES Bronchoscopy revealed tracheal anomalies and subsequent computed tomography angiography demonstrated the presence of a pulmonary artery sling (PAS), which confirmed the diagnosis of PAS accompanied with FBA. INTERVENTIONS With the assistance of CPB, multidisciplinary treatment involving the respiratory, cardiothoracic and anesthetic teams were involved and the bronchial FB was removed by flexible bronchoscopy successfully and then PAS was corrected by surgical intervention. OUTCOMES The patient remained asymptomatic, without shortness of breath or wheezing during the 15 months follow-up. LESSONS This case highlights that in a complicated case of FBA, bronchoscopy and computed tomography imaging are of great importance to achieve an accurate diagnosis, and a multidisciplinary treatment approach is essential for a satisfactory outcome. If the patient is unstable for bronchoscopy, CPB can be temporarily used in the stabilization of the patient to allow safe removal of the FB.
Collapse
Affiliation(s)
- Shuxian Li
- Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
- Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Lei Wu
- Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
- Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Meixia Huang
- Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
- Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Junfen Zhou
- Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
- Department of Pediatrics, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang, China
| | - Yingshuo Wang
- Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
- Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Zhimin Chen
- Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| |
Collapse
|
6
|
Shen Y, Li K, Chen P, Yu Y, Chen F. Asphyxia caused by delayed subglottic stenosis after neck trauma. Forensic Sci Med Pathol 2021; 17:481-485. [PMID: 34263414 DOI: 10.1007/s12024-021-00391-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 10/20/2022]
Abstract
Delayed subglottic stenosis (SGS) is an unusual complication. Here, we report a particular case of delayed SGS. A 17-year-old female suffered extensive injuries including severe neck trauma in a car accident, and complained of dyspnea after 30 days. Tracheal stenosis was observed by fiber optic bronchoscopy, but no specific treatment was administered to the patient. While being transferred to a tertiary hospital 3 days later, the patient fell into deep coma due to hypoxia, and died of hypoxic-ischemic encephalopathy and severe pulmonary infection in the intensive care unit (ICU) 58 days later. Postmortem autopsy and pathological investigation revealed tracheal stenosis 3.0 cm below the vocal cords with a diameter of 0.5 cm, which was caused by a cricoid cartilage fracture, fibrous tissue proliferation and inflammatory cell infiltration. We believed that external forces caused the cricoid fracture and mucosal damage, and after a month of fibrous repair, scar tissue formed the stenosis and caused her death. This report describes a rare condition in which slowly progressive intralaryngeal stenosis formation after external neck trauma could cause asphyxial death in a previously asymptomatic adult.
Collapse
Affiliation(s)
- Yueyao Shen
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, 200063, China.,Department of Forensic Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Kai Li
- Department of Forensic Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu, China.,Forensic Expertise Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Peng Chen
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, 200063, China.,Department of Forensic Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu, China.,Forensic Expertise Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Youjia Yu
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, 200063, China. .,Department of Forensic Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu, China. .,Forensic Expertise Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
| | - Feng Chen
- Department of Forensic Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu, China. .,Forensic Expertise Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China. .,Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu, China.
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Abstract
OBJECTIVE Review a single-centre experience with pulmonary artery sling repair and evaluate risk factors for re-intervention. METHODS Patients with surgically repaired pulmonary artery sling at a single institution between 1996 and 2018 were retrospectively reviewed. A univariate Cox regression analysis was used to evaluate variables for association with freedom from re-intervention. RESULTS Eighteen patients had pulmonary artery sling repair. At operation, median age and weight were 6.9 months (interquartile range 4.1-18.1) and 9.5 kg (interquartile range 6.5-14.5), respectively. A median hospital length of stay was 12 days (interquartile range 5.8-55.3). Twelve patients (67%) had complete tracheal rings, of whom six (50%) underwent tracheoplasty (five concurrently with pulmonary artery sling repair). Airway re-intervention was required in five (83%) of the six patients who underwent tracheoplasty. One patient had intraoperative diagnosis and repair of pulmonary artery sling during unrelated lesion repair and required tracheoplasty 24 days post-operatively. One patient died 55 days after pulmonary artery sling repair and tracheoplasty following multiple arrests and re-interventions. Median post-operative follow-up for surviving patients was 6.3 years (interquartile range 11 months-13 years), at which time freedom from re-intervention was 61%. When controlling for patient and tracheal size, initial tracheoplasty was associated with decreased freedom from re-intervention (hazard ratio 21.9, 95% confidence interval 1.7-284.3, p = 0.018). CONCLUSIONS In patients with pulmonary artery sling, tracheoplasty is associated with decreased freedom from re-intervention. In select patients with pulmonary artery sling and complete tracheal rings, conservative management without tracheoplasty is feasible. Further study is necessary to delineate objective indications for tracheoplasty.
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Hobbs RD, Moon J, Murala J, Ohye RG. Novel Suture Technique for Slide Tracheoplasty for the Treatment of Long-Segment Tracheal Stenosis. Semin Thorac Cardiovasc Surg 2020; 32:930-934. [DOI: 10.1053/j.semtcvs.2019.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/13/2019] [Indexed: 11/11/2022]
|
12
|
Sinner DI, Carey B, Zgherea D, Kaufman KM, Leesman L, Wood RE, Rutter MJ, de Alarcon A, Elluru RG, Harley JB, Whitsett JA, Trapnell BC. Complete Tracheal Ring Deformity. A Translational Genomics Approach to Pathogenesis. Am J Respir Crit Care Med 2019; 200:1267-1281. [PMID: 31215789 PMCID: PMC6857493 DOI: 10.1164/rccm.201809-1626oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 06/17/2019] [Indexed: 12/12/2022] Open
Abstract
Rationale: Complete tracheal ring deformity (CTRD) is a rare congenital abnormality of unknown etiology characterized by circumferentially continuous or nearly continuous cartilaginous tracheal rings, variable degrees of tracheal stenosis and/or shortening, and/or pulmonary arterial sling anomaly.Objectives: To test the hypothesis that CTRD is caused by inherited or de novo mutations in genes required for normal tracheal development.Methods: CTRD and normal tracheal tissues were examined microscopically to define the tracheal abnormalities present in CTRD. Whole-exome sequencing was performed in children with CTRD and their biological parents ("trio analysis") to identify gene variants in patients with CTRD. Mutations were confirmed by Sanger sequencing, and their potential impact on structure and/or function of encoded proteins was examined using human gene mutation databases. Relevance was further examined by comparison with the effects of targeted deletion of murine homologs important to tracheal development in mice.Measurements and Main Results: The trachealis muscle was absent in all of five patients with CTRD. Exome analysis identified six de novo, three recessive, and multiple compound-heterozygous or rare hemizygous variants in children with CTRD. De novo variants were identified in SHH (Sonic Hedgehog), and inherited variants were identified in HSPG2 (perlecan), ROR2 (receptor tyrosine kinase-like orphan receptor 2), and WLS (Wntless), genes involved in morphogenetic pathways known to mediate tracheoesophageal development in mice.Conclusions: The results of the present study demonstrate that absence of the trachealis muscle is associated with CTRD. Variants predicted to cause disease were identified in genes encoding Hedgehog and Wnt signaling pathway molecules, which are critical to cartilage formation and normal upper airway development in mice.
Collapse
Affiliation(s)
- Debora I. Sinner
- Division of Neonatology
- Division of Pulmonary Biology
- Department of Pediatrics and
| | | | | | - K. M. Kaufman
- Center for Autoimmune Genomics and Etiology, and
- Department of Pediatrics and
- U.S. Department of Veterans Affairs Medical Center, Cincinnati, Ohio
| | - Lauren Leesman
- Division of Neonatology
- Division of Pulmonary Biology
- Department of Pediatrics and
| | | | - Michael J. Rutter
- Division of Ear Nose and Throat Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Alessandro de Alarcon
- Division of Ear Nose and Throat Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ravindhra G. Elluru
- Division of Ear Nose and Throat Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - John B. Harley
- Center for Autoimmune Genomics and Etiology, and
- Department of Pediatrics and
- U.S. Department of Veterans Affairs Medical Center, Cincinnati, Ohio
| | - Jeffrey A. Whitsett
- Division of Neonatology
- Division of Pulmonary Biology
- Department of Pediatrics and
| | - Bruce C. Trapnell
- Division of Neonatology
- Division of Pulmonary Biology
- Translational Pulmonary Science Center
- Department of Pediatrics and
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
| |
Collapse
|
13
|
Yamoto M, Fukumoto K, Sekioka A, Iwazaki T, Sano K, Takahashi T, Nakaya K, Nomura A, Yamada Y, Urushihara N. Non-operative management of congenital tracheal stenosis: criteria by computed tomography. Pediatr Surg Int 2019; 35:1123-1130. [PMID: 31410561 DOI: 10.1007/s00383-019-04532-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Whether to perform surgical or conservative treatment for congenital tracheal stenosis (CTS) is controversial. Thus, the computed tomography (CT) criteria for conservative treatment of CTS were investigated. METHODS From 2005 to 2017, 28 CTS cases were included. The operative cases and preoperative death cases constituted the required intervention group (group I), and the non-operative surviving cases constituted the observation group (group O). The diameter of the tracheal narrowest part (DTNP) on CT was evaluated as a criterion for non-operative follow-up. RESULTS Chest CT was performed 19 times in 19 group I cases and 18 times in 9 group O cases. The median age of the patients that underwent CT scan examinations was 3.4 months (range 0-25 months) in group I and 22 months (range 0-60 months) in group O. The cut-off values of the non-operative criteria were 40.8% (AUC: 0.82, p < .01) normal for age of the trachea's narrowest part, and 41.6% normal for body weight (AUC: 0.92, p < .01), respectively. CONCLUSIONS DTNP is 40% and more of the normal diameter appears necessary for non-surgical management. The present study suggests that the criteria for conservative management of CTS are that the DTNP is not less than 40% of the normal tracheal diameter, with a few symptoms.
Collapse
Affiliation(s)
- Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan.
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Akinori Sekioka
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Teruo Iwazaki
- Department of Radiology, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Kyouhei Sano
- Department of Radiology, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Toshiaki Takahashi
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Kengo Nakaya
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Akiyoshi Nomura
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Yutaka Yamada
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| |
Collapse
|
14
|
Arunathan R, Ariffin AHZ, Khor KG, Tan SN. Isolated congenital tracheal stenosis: A rare and deadly condition. Pediatr Investig 2019; 3:191-193. [PMID: 32851317 PMCID: PMC7331346 DOI: 10.1002/ped4.12148] [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: 05/22/2019] [Accepted: 07/28/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Congenital tracheal stenosis (CTS) is a serious and rare condition. In most cases, CTS is associated with cardiopulmonary abnormalities; however, isolated CTS is present in 10%-30% of patients. The severity of the disorder is dependent on the symptoms, which correlate with the CTS classification. CASE PRESENTATION We discuss our findings in an infant who presented with severe respiratory compromise where incidental intra-operative findings revealed CTS with no cardiopulmonary abnormalities. Because of a lack of resources in the emergency department, we created a tracheostoma and inserted an endotracheal tube. CONCLUSION The main aim in treating CTS is to secure the airway and provide sufficient oxygen.
Collapse
Affiliation(s)
| | | | - Kee Guan Khor
- Department of OtorhinolarygologyHead & Neck Surgery, Hospital TawauSabahMalaysia
| | - Shi Nee Tan
- Department of OtorhinolarygologyHead & Neck Surgery Hospital Lahad DatuSabahMalaysia
- Department of OtorhinolarygologyHead & Neck Surgery, Hospital TawauSabahMalaysia
- Department of OtorhinolarygologyHead & Neck Surgery, KPJ Health care University CollegeSelangorMalaysia
| |
Collapse
|
15
|
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.
Collapse
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.
| |
Collapse
|
16
|
Complete tracheal rings and hypoplastic left heart variant: a rare and fatal association. Cardiol Young 2019; 29:445-447. [PMID: 30698130 DOI: 10.1017/s1047951118002391] [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] [Indexed: 11/07/2022]
Abstract
Congenital complete tracheal rings are usually associated with pulmonary slings. We report a rare association of congenital complete tracheal rings with hypoplastic left heart variant. A term infant with diagnosis of a mildly hypoplastic mitral valve, unicuspid aortic valve, and moderately hypoplastic aortic arch with severe coarctation underwent a hybrid procedure initially. Upon failing extubation attempts, complete tracheal rings were seen on direct laryngoscopy. The combination of the lesions resulted in a poor outcome. In patients with failure of extubation post-cardiac surgery, a diagnosis of complete tracheal rings should be included in the differential and a direct laryngoscopy should be considered.
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Xue B, Liang B, Yuan G, Zhu L, Wang H, Lu Z, Xu Z. A pilot study of a novel biodegradable magnesium alloy airway stent in a rabbit model. Int J Pediatr Otorhinolaryngol 2019; 117:88-95. [PMID: 30579096 DOI: 10.1016/j.ijporl.2018.10.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To preliminarily investigate the feasibility of bioabsorption tracheal stenting for the therapeutic application of congenital tracheal stenosis (CTS). STUDY DESIGN Experimental research. SETTING Shanghai Children Medical Center, National Children's Medical Center. SUBJECTS AND METHODS Five kinds of magnesium alloys with different compositions were studied in this paper, a patented Mg-Nd-Zn-Zr alloy series namely JDBM (JiaoDa BioMg) and four Mg-Ca-Zn alloys. The cytotoxicity of alloys was evaluated by the MTS ([3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assay in rabbit tracheal epithelial cells. Specific magnesium alloys had been immersed in the cell culture medium for 24 h. The tracheal stents that were made of magnesium alloy were implanted into the trachea of New Zealand rabbits and the ablation of the stent was monitored by fiber bronchoscopy. The routine blood examination was conducted prior to and following the stent placement. The rabbits were euthanized following 2-3 months of stenting. H&E staining of the main organs was conducted and the induction of apoptosis of the tracheal tissues was monitored. RESULTS The cytotoxicity of the JDBM magnesium alloy was mild and lower than the remaining 4 alloys. The stents were placed successfully in five animals. The tracheal stents were successfully placed and gradually biodegradated as monitored by fiber bronchoscopy; no significant systemic inflammatory response was noted. No significant differences in the liver and/or kidney function prior to and following stent placement were noted. H&E staining indicated the absence of pathological changes in the trachea, liver, heart and/or kidney tissues. The apoptotic assay indicated that the apoptosis ratio of the tracheal tissues was comparable between rabbits with and without tracheal stenting. CONCLUSION The results suggested the feasibility of bioabsorption stents made of biodegradable magnesium alloys using in patients with tracheal stenosis, especially in infants.
Collapse
Affiliation(s)
- Bangde Xue
- Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Department of Cardiovascular Surgery, Shanghai, China; Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Department of Cardiovascular Surgery, Shanghai, China
| | - Beibei Liang
- Shanghai University of Medicine and Health Sciences, Shanghai, China; Biology Research Center, University of Shanghai for Science and Technology, Shanghai, China
| | - Guangyin Yuan
- School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Limin Zhu
- Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Department of Cardiovascular Surgery, Shanghai, China
| | - Hao Wang
- Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Department of Cardiovascular Surgery, Shanghai, China
| | - Zhaohui Lu
- Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Department of Cardiovascular Surgery, Shanghai, China.
| | - Zhiwei Xu
- Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Department of Cardiovascular Surgery, Shanghai, China.
| |
Collapse
|
19
|
Usui Y, Ono S, Baba K, Tsuji Y. Pitfalls in the management of congenital tracheal stenosis: is conservative management feasible? Pediatr Surg Int 2018; 34:1035-1040. [PMID: 30099581 DOI: 10.1007/s00383-018-4329-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 03/07/2023]
Abstract
PURPOSE Congenital tracheal stenosis (CTS) is rare and challenging. Complete tracheal rings cause a wide spectrum of airway-obstructing lesions and varying degrees of respiratory distress. Although surgical reconstruction is the primary option for symptomatic CTS, sometimes an appropriate management strategy may be difficult due to other anomalies. We aimed to identify pitfalls in the management of CTS. METHODS We retrospectively reviewed the records of patients with CTS during the last 10 years in our institution. RESULTS Sixteen pediatric patients were diagnosed with CTS. Of the 16 patients, 12 (75.0%) had cardiovascular anomalies including seven left pulmonary artery sling. Six patients with dyspnoea caused by CTS and three patients with difficult intubations due to CTS underwent tracheoplasty. Four patients underwent only cardiovascular surgery without tracheoplasty. Three asymptomatic patients were followed up without undergoing any surgical procedure. We repeatedly discussed management of four patients with especially complex pathophysiology at multidisciplinary meetings. Right ventricular outflow tract obstruction, tracheobronchial malacia, increased pulmonary blood flow, and pulmonary aspiration due to gastroesophageal reflux presumably accounted for their severe respiratory distress, and we forewent their tracheal reconstruction. CONCLUSION The management of CTS should be individualized, and conservative management is a feasible option in selected cases.
Collapse
Affiliation(s)
- Yoshiko Usui
- Department of Pediatric Surgery, Jichi Children's Medical Center Tochigi, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shigeru Ono
- Department of Pediatric Surgery, Jichi Children's Medical Center Tochigi, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Katsuhisa Baba
- Department of Pediatric Surgery, Jichi Children's Medical Center Tochigi, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yuki Tsuji
- Department of Pediatric Surgery, Jichi Children's Medical Center Tochigi, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| |
Collapse
|
20
|
Donato L, Mai Hong Tran T, Ghori UK, Musani AI. Pediatric Interventional Pulmonology. Clin Chest Med 2018; 39:229-238. [DOI: 10.1016/j.ccm.2017.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
21
|
Antón-Pacheco JL, Morante R. Operative or non-operative treatment of congenital tracheal stenosis: is there something new? J Thorac Dis 2017; 9:4878-4880. [PMID: 29312681 DOI: 10.21037/jtd.2017.11.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Juan L Antón-Pacheco
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Rocio Morante
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
22
|
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.
Collapse
|
23
|
Navazo Eguía AISABEL, ANTÓN-PACHECO SÁNCHEZ JUANLUIS. Obstrucción crónica de la vía aérea en la infancia. Causas más frecuentes. Tratamiento quirúrgico y endoscópico. REVISTA ORL 2017. [DOI: 10.14201/orl.15901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
24
|
Agarwal A, Nakao M, Rajadurai VS, Chandran S. Neonatal airway: challenging endotracheal intubation in infants with tracheal malformations at birth. BMJ Case Rep 2017; 2017:bcr-2016-218818. [PMID: 28408368 DOI: 10.1136/bcr-2016-218818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Intubating newborn infants can be exacting. We describe two cases of endotracheal intubations in infants born with tracheal malformations. A male infant aged 30 weeks required intubation at birth for respiratory distress. Repeated attempts at intubation failed to achieve an optimal endotracheal tube position as the tube could not advance beyond the vocal cords. Hence ventilation continued with suboptimal air entry in the lungs. Bronchoscopy and CT scan confirmed tracheal stenosis. Slide tracheoplasty was successfully executed on day 78 of life. A female infant aged 33 weeks was intubated at birth for perinatal depression. Attempts at intubation were unsuccessful due to non-visualisation of the laryngeal inlet. Oesophagus was intubated and attempts to inflate showed air entry in the lungs, suggesting a fistulous communication between oesophagus and airway. A contrast oesophagogram showed a fistula connecting oesophagus and carina. With airway patency in question and associated major anomalies, parents were counselled and support was withdrawn.
Collapse
Affiliation(s)
- Arpan Agarwal
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Masakazu Nakao
- Department of Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore
| | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore
| | - Suresh Chandran
- Department of Neonatology, KK Women's and Children's Hospital, Singapore .,Yong Loo Lin School of Medicine, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore
| |
Collapse
|
25
|
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
|
26
|
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
| |
Collapse
|
27
|
Schweiger C, Cohen AP, Rutter MJ. Tracheal and bronchial stenoses and other obstructive conditions. J Thorac Dis 2016; 8:3369-3378. [PMID: 28066618 DOI: 10.21037/jtd.2016.11.74] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although tracheal stenosis and bronchial stenosis are relatively rare in the pediatric population, they are both associated with significant morbidity and mortality. While most cases of congenital tracheal stenosis in children present as complete tracheal rings (CTRs), other congenital tracheal obstructions are also encountered in clinical practice. In addition, acquired obstructive tracheal conditions stemming from endotracheal trauma or previous surgical interventions may occur. Many affected children also have associated cardiovascular malformations, further complicating their management. Optimal management of children with tracheal or bronchial stenoses requires comprehensive diagnostic evaluation and optimization prior to surgery. Slide tracheoplasty has been the operative intervention of choice in the treatment of the majority of these children.
Collapse
Affiliation(s)
- Claudia Schweiger
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aliza P Cohen
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; ; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
28
|
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.
Collapse
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.
| |
Collapse
|
29
|
Tracheal cartilaginous sleeves in children with syndromic craniosynostosis. Genet Med 2016; 19:62-68. [PMID: 27228464 DOI: 10.1038/gim.2016.60] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/29/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Because a tracheal cartilaginous sleeve (TCS) confers a significant mortality risk that can be mitigated with appropriate intervention, we sought to describe the prevalence and associated genotypes in a large cohort of children with syndromic craniosynostosis. METHODS Chart review of patients with syndromic craniosynostosis across two institutions. RESULTS In a cohort of 86 patients with syndromic craniosynostosis, 31 required airway evaluation under anesthesia. TCS was found in 19, for an overall prevalence of 22%. FGFR2, TWIST1, and FGFR3 mutations were identified in children with TCS. All five children with a W290C mutation in FGFR2 had TCS, and most previously reported children with W290C had identification of TCS or early death. In contrast, TCS was not associated with other mutations at residue 290. CONCLUSION There is an association between TCS and syndromic craniosynostosis, and it appears to be particularly high in individuals with the W290C mutation in FGFR2. Referral to a pediatric otolaryngologist and consideration of operative airway evaluation (i.e., bronchoscopy or rigid endoscopy) in all patients with syndromic craniosynostosis should be considered to evaluate for TCS. Results from genetic testing may help providers weigh the risks and benefits of early airway evaluation and intervention in children with higher-risk genotypes.Genet Med 19 1, 62-68.
Collapse
|
30
|
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.
Collapse
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.
| |
Collapse
|
31
|
Kopelovich JC, Wine TM, Rutter MJ, Mitchell MB, Prager JD. Secondary Reverse Slide Tracheoplasty for Airway Rescue. Ann Thorac Surg 2016; 101:1205-7. [DOI: 10.1016/j.athoracsur.2015.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 07/27/2015] [Accepted: 08/07/2015] [Indexed: 10/22/2022]
|
32
|
Clark ES, Best C, Onwuka E, Sugiura T, Mahler N, Bolon B, Niehaus A, James I, Hibino N, Shinoka T, Johnson J, Breuer CK. Effect of cell seeding on neotissue formation in a tissue engineered trachea. J Pediatr Surg 2016; 51:49-55. [PMID: 26552897 PMCID: PMC4824302 DOI: 10.1016/j.jpedsurg.2015.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 10/06/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Surgical management of long segment tracheal disease is limited by a paucity of donor tissue and poor performance of synthetic materials. A potential solution is the development of a tissue-engineered tracheal graft (TETG) which promises an autologous airway conduit with growth capacity. METHODS We created a TETG by vacuum seeding bone marrow-derived mononuclear cells (BM-MNCs) on a polymeric nanofiber scaffold. First, we evaluated the role of scaffold porosity on cell seeding efficiency in vitro. We then determined the effect of cell seeding on graft performance in vivo using an ovine model. RESULTS Seeding efficiency of normal porosity (NP) grafts was significantly increased when compared to high porosity (HP) grafts (NP: 360.3 ± 69.19 × 10(3) cells/mm(2); HP: 133.7 ± 22.73 × 10(3) cells/mm(2); p<0.004). Lambs received unseeded (n=2) or seeded (n=3) NP scaffolds as tracheal interposition grafts for 6 weeks. Three animals were terminated early owing to respiratory complications (n=2 unseeded, n=1 seeded). Seeded TETG explants demonstrated wound healing, epithelial migration, and delayed stenosis when compared to their unseeded counterparts. CONCLUSION Vacuum seeding BM-MNCs on nanofiber scaffolds for immediate implantation as tracheal interposition grafts is a viable approach to generate TETGs, but further preclinical research is warranted before advocating this technology for clinical application.
Collapse
Affiliation(s)
- Elizabeth S. Clark
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive – Suite WB4154, Columbus, OH, 43205,Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, 1900 Coffey Road, Columbus, OH, 43210
| | - Cameron Best
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive – Suite WB4154, Columbus, OH, 43205
| | - Ekene Onwuka
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive – Suite WB4154, Columbus, OH, 43205,Department of Surgery, The Ohio State University, 395 W. 12th Avenue – Suite 670, Columbus, OH, 43210
| | - Tadahisa Sugiura
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive – Suite WB4154, Columbus, OH, 43205
| | - Nathan Mahler
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive – Suite WB4154, Columbus, OH, 43205
| | - Brad Bolon
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, 1900 Coffey Road, Columbus, OH, 43210,Comparative Pathology and Mouse Phenotyping Shared Resource, College of Veterinary Medicine, The Ohio State University, 1900 Coffey Road, Columbus, OH, 43210
| | - Andrew Niehaus
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp Street, Columbus, OH, 43210
| | - Iyore James
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive – Suite WB4154, Columbus, OH, 43205
| | - Narutoshi Hibino
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive – Suite WB4154, Columbus, OH, 43205,Department of Cardiothoracic Surgery, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205
| | - Toshiharu Shinoka
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive – Suite WB4154, Columbus, OH, 43205,Department of Cardiothoracic Surgery, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205
| | - Jed Johnson
- Nanofiber Solutions, Inc., 1275 Kinnear Road, Columbus, OH, 43212
| | - Christopher K. Breuer
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive – Suite WB4154, Columbus, OH, 43205,Department of Pediatric Surgery, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205
| |
Collapse
|
33
|
Mehta AC, Thaniyavarn T, Ghobrial M, Khemasuwan D. Common Congenital Anomalies of the Central Airways in Adults. Chest 2015; 148:274-287. [PMID: 25811532 DOI: 10.1378/chest.14-1788] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The knowledge of airway anatomy is the most fundamental requirement of every bronchoscopist. There are numerous and frequent anatomic variations of the central airways making the examination unique for every individual. It is imperative for every bronchoscopist to be fully cognizant of the common congenital anomalies involving the central airways. Proper identification and reporting of these findings are a matter of the utmost importance, especially when surgical options in a patient with lung cancer or lung transplantation is under consideration. This article focuses on the congenital anomalies of central airway encountered among adults. Each of these anatomic variations has a characteristic appearance, yet requires bronchoscopic acumen for their identification. This review provides a comprehensive description of these anomalies and highlights their clinical implications.
Collapse
Affiliation(s)
- Atul C Mehta
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| | - Tany Thaniyavarn
- Department of Pulmonary, Allergy, and Critical Care Medicine, Emory University, Atlanta, GA
| | - Michael Ghobrial
- Internal Medicine Department, Fairview Hospital, a Cleveland Clinic Hospital, Cleveland, OH
| | - Danai Khemasuwan
- Interventional Pulmonary Medicine, Henry Ford Hospital, Detroit, MI
| |
Collapse
|
34
|
Razumovskiĭ AI, Afukov II, Kulaev AD, Alkhasov AB, Mitupov ZB, Kulikova NV, Stepanenko NS. [Sliding traсheal plasty in children under extracorporeal membrane oxygenation (first experience in Russia)]. Khirurgiia (Mosk) 2015:4-13. [PMID: 26356052 DOI: 10.17116/hirurgia201584-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To improve the results of surgical treatment of children with extended tracheal stenosis. MATERIAL AND METHODS Since 2013 slidingtraсheal plasty under extracorporeal membrane oxygenation was performed in 4 children aged 1 year 2 months - 4.5 years with extended tracheal stenosis in Children's City Clinical Hospital №13. Patients' weight was from 10,5 to 16 kg. Extended tracheal stenosis and complete cartilag inousrings were confirmed in all patients after peoperative survey. Indications for surgery were based on medical history data, the severity of respiratory failure and survey data. Sliding traсheal plasty by different approach esunder extracorporeal membrane oxygenation was applied in all patients. RESULTS There were no intraoperative complications. In the study group 1 patient died in remote postoperative period after discharge due to deterioration of his condition caused by upper respiratory tract infection and acute respiratory failure. In immediate postoperative period 1 patient had pronounced growth of granulation tissue in the area of anastomosis followed laser photocoagulation and prolonged intubation. The average ICU-stay was 24 days, the duration of mechanical ventilation - 11 days. Follow-up carefor patients was conducted on terms of 4-6 and 12 months after surgery. In 2 patients moderate complaints of recurrent bronchitis without signs of respiratory insufficiency during 6-8 months postoperatively were observed. In one child complaints were completely absent.
Collapse
Affiliation(s)
- A Iu Razumovskiĭ
- Chair of Pediatric Surgery, N.I. Pirogov Russian Research Medical University
| | - I I Afukov
- Chair of Pediatric Surgery, N.I. Pirogov Russian Research Medical University
| | - A D Kulaev
- N.F. Filatov Children's Clinical Hospital #13, Moscow
| | - A B Alkhasov
- Chair of Pediatric Surgery, N.I. Pirogov Russian Research Medical University
| | - Z B Mitupov
- Chair of Pediatric Surgery, N.I. Pirogov Russian Research Medical University
| | - N V Kulikova
- N.F. Filatov Children's Clinical Hospital #13, Moscow
| | - N S Stepanenko
- Chair of Pediatric Surgery, N.I. Pirogov Russian Research Medical University
| |
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|
36
|
Fandiño M, Kozak FK, Verchere C, Campbell A. Modified slide tracheoplasty in a newborn with bronchial and carinal stenosis. Int J Pediatr Otorhinolaryngol 2013; 77:2075-80. [PMID: 24139586 DOI: 10.1016/j.ijporl.2013.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/02/2013] [Accepted: 09/04/2013] [Indexed: 10/26/2022]
Abstract
Congenital tracheal stenosis (CTS) is a life-threatening condition that is associated with significant morbidity and mortality particularly when symptomatic presentation occurs in the newborn period. The most challenging form of CTS is long segment congenital tracheal stenosis (LSCTS) with compromise of the carina and main stem bronchi. We report the case of a newborn with severe distal tracheal stenosis with carinal and main stem bronchial involvement who was managed successfully with a modified slide and autologous rib graft tracheoplasty. The patient was discharged from hospital without ventilator support or oxygen requirement at 2 months of age. The details of this case and the description of the surgical procedure are presented and the related literature is reviewed.
Collapse
Affiliation(s)
- Marcela Fandiño
- Department of Surgery, Division of Pediatric Otolaryngology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | |
Collapse
|
37
|
A New Morphologic Classification of Congenital Tracheobronchial Stenosis. Ann Thorac Surg 2012; 93:958-61. [DOI: 10.1016/j.athoracsur.2011.12.019] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 11/20/2022]
|
38
|
Lee EY, Boiselle PM, Shamberger RC. Multidetector computed tomography and 3-dimensional imaging: preoperative evaluation of thoracic vascular and tracheobronchial anomalies and abnormalities in pediatric patients. J Pediatr Surg 2010; 45:811-21. [PMID: 20385293 DOI: 10.1016/j.jpedsurg.2009.12.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Revised: 12/10/2009] [Accepted: 12/14/2009] [Indexed: 01/09/2023]
Abstract
In the past decade, rapid technical developments and advancements of multidetector computed tomography (MDCT) have revolutionized the preoperative imaging evaluation of thoracic vascular and tracheobronchial anomalies and abnormalities in infants and children. Multidetector computed tomography enables noninvasive, rapid, high-resolution, and 3-dimensional (3D) imaging of the thorax in pediatric patients that provides comprehensive preoperative surgical guidance for pediatric surgeons. With the increasing availability of MDCT and 3D imaging, a practical review is needed for the pediatric surgeon of the evolving role of these techniques in the preoperative evaluation of surgical lesions in infants and children. This article focuses on the review of advantages and disadvantages of MDCT in comparison to other imaging modalities, 2D and 3D imaging postprocessing techniques, and MDCT and 3D imaging appearance of various thoracic vascular and tracheobronchial anomalies and abnormalities in pediatric patients. The primary aim of this article was to facilitate the pediatric surgeons' ability to successfully incorporate MDCT and 3D imaging as a routine preoperative imaging tool for the evaluation of thoracic surgical lesions in infants and children.
Collapse
Affiliation(s)
- Edward Y Lee
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
| | | | | |
Collapse
|
39
|
Drasković B, Uram-Benka A, Kljajić V. Laryngeal mask airway as the only choice for primary airway control in newborn with tracheal stenosis. MEDICINSKI PREGLED 2010; 63:275-279. [PMID: 21049697 DOI: 10.2298/mpns1004275d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Congenital tracheal stenosis is a rare disorder characterized by the presence of focal or diffuse complete tracheal cartilage rings, resulting in afixed tracheal narrowing. The prognosis for this disorder is currently assumed to be poor, with some sources stating that the natural outcome of this problem is inevitably fatal. Tracheal stenosis requires a tracheostomy at delivery for the infant to survive before the definitive reconstruction. The laryngeal mask airway is the most commonly used airway device in pediatric anaesthesia as well as the primary airway control during the resuscitation. We present a premature infant with congenital tracheal stenosis, in whom the airway could be controlled only by the laringeal mask. In this case the laryngeal mask airway was a life saving device for the airway control in the period before tracheostomy was done. Tracheostomy was made in first few hours after birth. In severe tracheal stenosis the laryngeal mask airway can be a device of choice for the initial control of the airway.
Collapse
Affiliation(s)
- Biljana Drasković
- Klinika za decju hirurgiju, Institut za zdravstvenu zastitu dece i omladine Vojvodine, Novi Sad.
| | | | | |
Collapse
|
40
|
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]
|
41
|
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.
Collapse
Affiliation(s)
- Ricardo Mingarini Terra
- Department of Thoracic Surgery, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
42
|
Delgado Pecellín I, González Valencia JP, Machuca Contreras M, Pineda Mantecón M. [Clinic, diagnosis and treatment of tracheal stenosis]. An Pediatr (Barc) 2009; 70:443-8. [PMID: 19375994 DOI: 10.1016/j.anpedi.2008.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 10/16/2008] [Accepted: 12/14/2008] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION New surgical techniques have been developed for treatment of tracheal stenosis (TS) over the last few years. The aim of the present study is to examine the clinical, therapeutic characteristics and progress of the cases of TS diagnosed in our hospital from January 2004 to August 2007. METHODS We have reviewed the clinical history, focusing on age at diagnosis, clinical signs and symptoms, baseline pathology, previous history of mechanical ventilation, degree of stenosis, diagnostic technique, treatment and progress. RESULTS A total of 16 cases were found, (2 congenital and 14 acquired). Mean age at diagnosis was 8.8 months (23 days-2.5 years). Of these, 14 patients had been intubated (3-44 days). Clinical suspicion was prompted by inspiratory stridor (44%), difficulty to be extubated or intubated (28%) and recurrent laryngotracheitis (39%). Three patients received CO(2) laser therapy and suffered a high number of restenosis and required re-interventions. Three patients underwent costal cartilage tracheoplasty and tracheal-cricoid split, showing a good prognosis and one patient underwent a slide tracheoplasty. Five patients with only a few clinical signs and mild stenosis, were managed on a wait and see basis. One patient with tracheal membrane underwent resection of the stenosed portion and end-to-end anastomosis with favourable progress. Another patient had a partial cricotracheal resection but suffered three restenoses. Two patients underwent surgical correction of the vascular ring. CONCLUSIONS Asymptomatic patients may receive conservative therapy. In the case of short-segment stenosis, resection and end-to-end anastomosis is the therapy of choice and the long-segment stenosis has obtained good results by means of slide tracheoplasty, which involved no deaths and a very low morbidity.
Collapse
Affiliation(s)
- I Delgado Pecellín
- Unidad de Neumología Pediátrica, Hospital Infantil H.H.U.U.Virgen del Rocío, Sevilla, España.
| | | | | | | |
Collapse
|
43
|
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]
|
44
|
Törer B, Gülcan H, Oğuzkurt L, Oğuzkurt P, Tarcan A. Use of balloon-expandable metallic stent in a premature infant with congenital tracheobronchial stenosis. Pediatr Pulmonol 2008; 43:414-7. [PMID: 18286549 DOI: 10.1002/ppul.20788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A congenital tracheobronchial stenosis is a rare obstructive lesion of the airway characterized by intrinsic narrowing of a segment of the trachea and bronchi. In this report, we present the smallest premature infant with a congenital tracheobronchial stenosis who has been successfully treated with balloon dilatation and placement of a balloon-expandable metallic stent.
Collapse
Affiliation(s)
- Birgin Törer
- Baskent University Faculty of Medicine, Department of Neonatology, Adana, Turkey.
| | | | | | | | | |
Collapse
|
45
|
Abstract
Congenital bronchial stenosis is a very uncommon condition in children. A full-term neonate showed severe respiratory distress soon after birth. Bronchoscopy and spiral computed tomography with multiplanar reconstruction disclosed a short stenosis of the left main bronchus, next to the carina, and another stenosis in the intermediate bronchus with air trapping in the right middle and lower lobes. The child underwent resection and reconstruction of the left main bronchus, and right middle and lower lobectomies after a failed attempt of bronchoscopic dilatation of the intermediate bronchus. A temporary silicon tracheal stent was necessary to achieve permanent extubation. The patient was discharged in good condition without any oxygen dependency and remains asymptomatic 1 year after surgery. Management of children with airway stenosis is complex, and surgeons involved in it should be familiar with multiple surgical and endoscopic techniques. A team approach in a referral center is the best option to achieve an optimal result.
Collapse
|
46
|
Herrera P, Caldarone C, Forte V, Campisi P, Holtby H, Chait P, Chiu P, Cox P, Yoo SJ, Manson D, Kim PCW. The current state of congenital tracheal stenosis. Pediatr Surg Int 2007; 23:1033-44. [PMID: 17712567 DOI: 10.1007/s00383-007-1945-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2007] [Indexed: 10/22/2022]
Abstract
Congenital tracheal stenosis (CTS) is an uncommon condition that has challenged pediatric surgeons for decades. Patients with CTS can present with a wide spectrum of symptoms and varying degrees of severity. In addition, a variety of techniques have been devised to repair this malformation. A review of these procedures and our suggestions for clinical standards and practice guidelines will be presented in this paper. A retrospective review of the literature on CTS from 1964 to 31 March, 2006. There is not one standard technique for the repair of CTS, as individualized approach to each patient and airway lesion is necessary to optimize patient management; nevertheless there is a consensus about segmental resection and anastomosis being best for short segment stenosis while slide tracheoplasty is most effective for the long-segment ones. Conservative management is also an option for select group of patients with careful and close follow up. Survival following surgery over the years has improved, but mortality remained high, particularly in a specific subset of patients presenting at the age less than 1 month with associated cardiac malformations. In conclusion, CTS remains a significant challenge for pediatric surgeons. Additional research is required to improve our understanding of the pathogenesis of CTS, and to develop evidence-based treatment protocols for the entire spectrum of presentation including conservative management.
Collapse
Affiliation(s)
- P Herrera
- The Airway Reconstruction Team, The Hospital for Sick Children, 555 University Avenue, Room 1286, Toronto, ON, Canada M5G 1X8.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
Chest radiographs have been useful for the incidental detection and initial imaging evaluation of clinically suspected central airway narrowing in pediatric patients. However, cross-sectional imaging, such as computed tomography (CT), is frequently required for confirmation of diagnosis, further characterization, and preoperative evaluation of surgical lesions. Recent rapid technologic advancement in CT has allowed CT to assume a pivotal role in the noninvasive evaluation of tracheobronchial narrowing in children, in particular with multidetector computed tomography with postprocessing techniques, including multiplanar reformations and 3-dimensional reconstructions. In this article, the authors review the multidetector computed tomography technique for evaluation of central airway narrowing in children, with emphasis on the use of multiplanar reformations and 3-dimensional reconstructions in the imaging evaluation of the spectrum of intrinsic and extrinsic causes of central airway narrowing in children.
Collapse
Affiliation(s)
- Edward Y Lee
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
| | | |
Collapse
|
48
|
Cheng W, Manson DE, Forte V, Ein SH, MacLusky I, Papsin BC, Hechter S, Kim PCW. The role of conservative management in congenital tracheal stenosis: an evidence-based long-term follow-up study. J Pediatr Surg 2006; 41:1203-7. [PMID: 16818049 DOI: 10.1016/j.jpedsurg.2006.03.046] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE Surgery has been the management of choice for severe congenital tracheal stenosis (CTS). The role of conservative management of CTS however is not clear. The aim of this study is to characterize the natural history of CTS, review the radiologic evidence of tracheal growth, and evaluate the clinical outcome and selection criteria of conservative management of CTS. METHODS A retrospective study was carried out on 22 consecutive children with symptomatic CTS admitted into a single institution between 1982 and 2001. The patients were categorized into operation (n = 11) and observation (n = 11) groups. Six patients of the observation group were followed up with serial computed tomography scan. Their tracheal growth was compared with that of healthy children of the same age. RESULTS The mortality rates of observation and operation groups were 9% and 27%, respectively, although the latter group consisted of more severely affected patients. The pathologic categorization of the CTS influenced the survival rates (P = .046, chi2), with the long segment type having the worst prognosis (67%). Serial computed tomography scans of 6 conservatively managed patients revealed that all stenotic tracheas continued to grow (P = .039, 2-tailed paired Student's t test). Of the 6 stenotic tracheas, 5 grew at a faster-than-normal rate, and the stenotic tracheal diameters approached those of normal diameters by the age of 9 years. CONCLUSIONS The management of patients with symptomatic CTS should be individualized. A selected group of patients with CTS can be safely managed nonoperatively.
Collapse
Affiliation(s)
- Wei Cheng
- Division of General Surgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada 5G 1X8
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Affiliation(s)
- Lorri M. Phipps
- Lorri M. Phipps is a pediatric nurse practitioner and Jill A. Raymond is a clinical staff nurse in the pediatric intensive care unit, Departments of Pediatrics and Nursing, Division of Critical Care, at Penn State Children’s Hospital, Hershey, Pa. Tammy M. Angeletti is a pediatric respiratory specialist in the Department of Pediatrics, Division of Respiratory Therapy, at Penn State Children’s Hospital
| | - Jill A. Raymond
- Lorri M. Phipps is a pediatric nurse practitioner and Jill A. Raymond is a clinical staff nurse in the pediatric intensive care unit, Departments of Pediatrics and Nursing, Division of Critical Care, at Penn State Children’s Hospital, Hershey, Pa. Tammy M. Angeletti is a pediatric respiratory specialist in the Department of Pediatrics, Division of Respiratory Therapy, at Penn State Children’s Hospital
| | - Tammy M. Angeletti
- Lorri M. Phipps is a pediatric nurse practitioner and Jill A. Raymond is a clinical staff nurse in the pediatric intensive care unit, Departments of Pediatrics and Nursing, Division of Critical Care, at Penn State Children’s Hospital, Hershey, Pa. Tammy M. Angeletti is a pediatric respiratory specialist in the Department of Pediatrics, Division of Respiratory Therapy, at Penn State Children’s Hospital
| |
Collapse
|
50
|
Abstract
We present here a 4 year old child with severe tracheal stenosis and respiratory failure. The patient was not responding to conventional ventilation settings and had significant hypercarbia. The difficulty in mechanical ventilation was handled successfully with specific ventilatory strategy: use of low respiratory rate, long inspiratory time and normal inspiratory time: expiratory time ratio. Thereafter the child was managed surgically and the stenosis was corrected. The child was discharged after a Montgomery T-tube placement.
Collapse
Affiliation(s)
- Rakesh Lodha
- Department of Pediatrics, AIIMS, New Delhi, India
| | | | | | | |
Collapse
|