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El-Said H, Price K, Hussein A, Ganta S, Rao A, Nigro J, Brigger MT. Bronchial Remodeling Following Airway Stenting in Pediatric Patients With Tracheobronchial and Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101068. [PMID: 39132388 PMCID: PMC11307877 DOI: 10.1016/j.jscai.2023.101068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/11/2023] [Accepted: 06/22/2023] [Indexed: 08/13/2024]
Abstract
Background Treatment of tracheobronchial disease in medically complex infants with congenital heart disease (CHD) is often challenging. When conservative management or surgery fails or is contraindicated, airway stenting can allow for advancement of care or weaning of respiratory support. Methods We identified 8 cases of airway stenting with balloon-expandable coronary bare-metal stents performed at our institution between February 2019 and September 2022 to relieve conservative treatment-refractory tracheobronchial disease in pediatric patients with CHD. All patients underwent rigid microlaryngoscopy, bronchoscopy, and flexible bronchoscopy as well as computed tomography angiography. Results Eight patients underwent technically uncomplicated placement of balloon-expandable coronary bare-metal stents in the trachea or bronchus. Immediate improvement in respiratory parameters was noted following stent placement. Six patients were able to wean mechanical ventilation following stent placement, with a median of 2.5 days of mechanical ventilation following the procedure (range, 0-219). All stents were subsequently endoscopically removed at a median of 6.8 months (range, 0.4-16.3 months). In 6 patients, bronchoscopy after stent removal demonstrated a rounder configuration of the airway consistent with bronchial remodeling. Conclusions In pediatric patients with tracheobronchial and CHD, airway stenting with balloon-expandable bare-metal coronary stents relieved respiratory symptoms with minimal complications and resulted in bronchial remodeling after stent removal.
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Affiliation(s)
- Howaida El-Said
- Pediatric Cardiology, Rady Children’s Hospital, San Diego, California
| | - Katherine Price
- University of California San Diego School of Medicine, San Diego, California
| | - Amira Hussein
- Pediatric Cardiology, Rady Children’s Hospital, San Diego, California
| | - Srujan Ganta
- Cardiothoracic Surgery, Rady Children’s Hospital, San Diego, California
| | - Aparna Rao
- Pediatric Pulmonology, Rady Children’s Hospital, San Diego, California
| | - John Nigro
- Cardiothoracic Surgery, Rady Children’s Hospital, San Diego, California
| | - Matthew T. Brigger
- Pediatric Otolaryngology, Rady Children’s Hospital, San Diego, California
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California
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Morante-Valverde R, Usategui A, López M, Grau M, Luna-Paredes MC, Albi S, Alonso-Riaño M, Pablos JL, Antón-Pacheco JL. Histological and structural effects of biodegradable polydioxanone stents in the rabbit trachea. Eur J Cardiothorac Surg 2022; 62:6628586. [PMID: 35781568 DOI: 10.1093/ejcts/ezac380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/03/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the potential biologic effects caused by successive placement of biodegradable polydioxanone (PDO) stents in the rabbit trachea. PDO stents could eventually induce a fibroproliferative reaction in the submucosa that could be beneficial in the treatment of malacia due to an increase in its consistency without impairing the tracheal lumen. METHODS Sixteen adult NZ rabbits were distributed into 3 groups with different survival times according to the number of stents placed: One stent (14 weeks), 2 stents (28 w.), and 3 stents (42 w.). Stent insertion was performed endoscopically in the cervical trachea of the animal. Histopathological studies included Masson's trichrome staining for submucosal fibrosis and Safranin O to assess structural integrity of cartilage. Potential inflammatory changes were analysed by means of immunohistochemistry determining the number of CD45 positive cells. RESULTS Stent placement was successful in every case. Histological studies did not show a statistically significant increase in tracheal wall collagen area and cartilage structure was not modified in those rabbits with one or more PDO stents inserted compared to non-stented tracheal sections. Furthermore, no statistically significant changes in the number of CD45+ cells were observed in stented tracheal segments compared to normal tracheal tissues. CONCLUSIONS According to our data, successive PDO stenting caused mild inflammatory changes in the tracheal wall, no increase in the collagen matrix, and the cartilaginous support was not modified during a long follow-up period (up to 42 weeks). These findings suggest that they may be safe and show good biocompatibility in the long-term.
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Affiliation(s)
- Rocío Morante-Valverde
- Pediatric Surgery Division & Pediatric Airway Unit. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Universidad Complutense de Madrid. Spain
| | - Alicia Usategui
- Inflammatory and Autoimmune Diseases Research Group. Instituto de Investigación Hospital U. 12 de Octubre (imas12). Avda. de Córdoba s/n, Madrid 28041. Spain
| | - María López
- Pediatric Surgery Division & Pediatric Airway Unit. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Universidad Complutense de Madrid. Spain
| | - Montserrat Grau
- Research Center, Veterinary Unit. Instituto de Investigación Hospital U. 12 de Octubre (imas12). Avda. de Córdoba s/n, Madrid 28041. Spain
| | - Ma Carmen Luna-Paredes
- Pulmonary Unit, Division of Pediatrics. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Spain
| | - Salomé Albi
- Pulmonary Unit, Division of Pediatrics. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Spain
| | - Marina Alonso-Riaño
- Division of Pathology. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Spain
| | - José L Pablos
- Inflammatory and Autoimmune Diseases Research Group. Instituto de Investigación Hospital U. 12 de Octubre (imas12). Avda. de Córdoba s/n, Madrid 28041. Spain
| | - Juan L Antón-Pacheco
- Pediatric Surgery Division & Pediatric Airway Unit. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Universidad Complutense de Madrid. Spain.,Inflammatory and Autoimmune Diseases Research Group. Instituto de Investigación Hospital U . 12 de Octubre (imas12). Avda. de Córdoba s/n, Madrid, 28041, . Spain
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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.
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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
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Bellia-Munzon G, Cieri P, Toselli L, Cuestas G, Doormann F, Gabaldón-Massé P, Rodriguez V, Bellia-Munzon P. Resorbable airway splint, stents, and 3D reconstruction and printing of the airway in tracheobronchomalacia. Semin Pediatr Surg 2021; 30:151063. [PMID: 34172216 DOI: 10.1016/j.sempedsurg.2021.151063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tracheobronchomalacia (TBM) is the most common tracheobronchial obstruction. Most cases are mild to moderate; therefore, they do not need surgical treatment. Severe tracheomalacia, however, represents a diagnostic and therapeutic challenge since they are very heterogeneous. In the armamentarium of resources for the treatment of dynamic airway collapse, splints and stents are two underused strategies and yet, they may represent the best alternative in selected cases. Lately, computed tomography 3D reconstruction of the airway has been used for the design of virtual models that can be 3D-printed for the creation of novel devices to address training, simulation, and biotechnological implants for refractory and severe airway malformations. This manuscript examines the role of resorbable stents, splints, and the 3D reconstruction and printing of the pediatric airway in tracheobronchomalacia.
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Affiliation(s)
- Gaston Bellia-Munzon
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Patricio Cieri
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina..
| | - Luzia Toselli
- Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Giselle Cuestas
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Flavia Doormann
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Paula Gabaldón-Massé
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Verónica Rodriguez
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Patricio Bellia-Munzon
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
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Kamran A, Zendejas B, Jennings RW. Current concepts in tracheobronchomalacia: diagnosis and treatment. Semin Pediatr Surg 2021; 30:151062. [PMID: 34172207 DOI: 10.1016/j.sempedsurg.2021.151062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Airway collapse from dynamic tracheobronchomalacia (TBM), static compression from vascular compression, and/or tracheobronchial deformation are challenging conditions. Patients are best assessed and managed by a multidisciplinary team in centers specializing in complex pediatric airway disorders. Suspicion is made through clinical history and physical examination, diagnosis of location and severity by dynamic 3-phase bronchoscopy, and surgical treatment planning by MDCT and other studies as necessary to completely understand the problems. The treatment plan should be patient-based with a thorough approach to the underlying pathology, clinical concerns, and combined abnormalities. Patients should undergo maximum medical therapy prior to committing to other interventions. For those children considered candidates for surgical intervention, all other associated conditions, including vascular anomalies, chest wall deformities, mediastinal lesions, or other airway pathologies, should also be considered. Our preference is to correct the airway lesions at the same operation as other comorbidities, if possible, to prevent multiple reoperations with their attendant increased risks. We also strongly advocate for the use of recurrent laryngeal nerve monitoring in all cases of cervical or thoracic surgery to minimize the risks to vocal cord function and laryngeal sensation. Studies that evaluate the effect of these interventions on the patient and caregiver's quality of life are needed to fully grasp the impact of TBM on this challenging patient population.
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Affiliation(s)
- Ali Kamran
- Esophageal and Airway Treatment Center, Department of Pediatric General Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Benjamin Zendejas
- Esophageal and Airway Treatment Center, Department of Pediatric General Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Russell W Jennings
- Esophageal and Airway Treatment Center, Department of Pediatric General Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
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Kamran A, Baird CW, Jennings RW. Tracheobronchomalacia, Tracheobronchial Compression, and Tracheobronchial Malformations: Diagnostic and Treatment Strategies. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2021; 23:53-61. [PMID: 32354548 DOI: 10.1053/j.pcsu.2020.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 11/11/2022]
Abstract
Tracheobronchomalacia (TBM) is an excessive dynamic narrowing of the airway that is greatest with increased mediastinal pressure such as coughing, Valsalva, and forced expiration. Airway compression and/or cartilage malformation is a fixed or static narrowing of the airway typically caused by great vessel malposition and/or abnormalities and may also contribute to airway narrowing. Although imprecise and misleading, the term TBM is often used to represent both problems, static and dynamic airway narrowing, which only serves to confuse and may mislead the treatment team into ineffective therapies. The consequences of airway narrowing caused by dynamic TBM and/or static compression includes a range of clinical signs and symptoms, depending on the location, extent, and severity of the airway collapse. All patients with mild to severe TBM benefit from medical management to optimize airway clearance of mucus. The milder cases of TBM may become asymptomatic with this therapy, allowing time for the child to grow and the airway to enlarge without the consequences of recurrent infections. In cases of more severe TBM with clinical sequelae, more aggressive management may be warranted. Multiple options for surgical intervention are available. This article discusses the details of clinical presentation, evaluation, diagnosis, and a variety of treatments.
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Affiliation(s)
- Ali Kamran
- Department of General Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Russell W Jennings
- Department of General Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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7
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Harada A, Shimojima N, Shimotakahara A, Azuma S, Ishizuka Y, Tomita H, Hirobe S. Surgical indication for congenital tracheal stenosis complicated by pulmonary artery sling. J Thorac Dis 2019; 11:5474-5479. [PMID: 32030266 DOI: 10.21037/jtd.2019.11.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Congenital tracheal stenosis (CTS) is a rare and life-threatening disease in children. Although pulmonary artery sling (PA sling) complicated by CTS sometimes occurs, there are few reports detailing the management of CTS with PA sling. The purpose of this retrospective study was to determine the appropriate indications for surgical intervention for CTS complicated by PA sling. Methods We evaluated 42 patients (19 males and 23 females) with the median age of 9.9±3.3 months (range, 5-34 months) with CTS complicated by PA sling who were treated at our hospital between 2005 and 2018. Twenty-eight patients received both a slide tracheoplasty and PA re-implantation, and 14 patients were managed conservatively for CTS. Among the latter, nine patients received PA re-implantation only, and five were managed conservatively without any surgery. We determined the surgical indications by retrospectively comparing the DLR value [tracheal diameter (mm)/stenotic length ratio], history of ventilator respiration, mortality rate, and post-operative course of patients at a single institution. Results The cut-off value for the DLR was determined to be 5.9 (sensitivity: 0.929, specificity: 0.714) by using the ROC curve (AUC 0.89, P<0.05). Conclusions A DLR value under 5.9 may serve as a new surgical indication for CTS complicated by PA sling.
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Affiliation(s)
- Atsushi Harada
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Naoki Shimojima
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | | | - Saya Azuma
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yoshiaki Ishizuka
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hirofumi Tomita
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Seiichi Hirobe
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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8
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Li Y, Yan J, Zhou W, Xiong P, Wang P, Yuan W, Zheng Y, Cheng Y. In vitro degradation and biocompatibility evaluation of typical biodegradable metals (Mg/Zn/Fe) for the application of tracheobronchial stenosis. Bioact Mater 2019; 4:114-119. [PMID: 31667439 PMCID: PMC6812134 DOI: 10.1016/j.bioactmat.2019.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/20/2019] [Accepted: 01/20/2019] [Indexed: 12/12/2022] Open
Abstract
Tracheobronchial obstruction in children due to benign stenosis or tracheobronchomalacia still remains a challenging matter of concern. Currently, there is 10%-20% complication rate in clinical treatment. The non-biodegradable property of silicone stents and nickel-titanium memory alloy stents take the primary responsibility for drawbacks including stimulating local granulation tissue proliferation, displacement, and stent-related infections. Permanent tracheobronchial stent will be a persistent foreign object for a long time, causing excessive secretion of tracheal mucosa, ulceration and even perforation, which is particularly unsuitable for young children with persistent tracheal growth. In this study, the degradation and biocompatibility performance of three typical biodegradable metals were investigated as potential tracheobronchial stent materials. The results exhibited that these materials showed different degradation behaviors in the simulating respiratory fluid environment compared with SBF. Except for pure iron group, high purity magnesium and zinc showed favorable cell adhesion and proliferation in three culture methodologies (direct culture, indirect culture and extraction culture). The proper corrosion rate and good biocompatibility indicated that high purity magnesium and zinc may be good candidates as tracheobronchial stent materials.
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Affiliation(s)
- Yangyang Li
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Jianglong Yan
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Wenhao Zhou
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Pan Xiong
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Pei Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Wei Yuan
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing, 100871, China
| | - Yufeng Zheng
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing, 100871, China
| | - Yan Cheng
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
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Kamran A, Jennings RW. Tracheomalacia and Tracheobronchomalacia in Pediatrics: An Overview of Evaluation, Medical Management, and Surgical Treatment. Front Pediatr 2019; 7:512. [PMID: 31921725 PMCID: PMC6922019 DOI: 10.3389/fped.2019.00512] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/26/2019] [Indexed: 01/13/2023] Open
Abstract
Tracheobronchomalacia (TBM) refers to airway collapse due to typically excessive posterior membrane intrusion and often associated with anterior cartilage compression. TBM occurs either in isolation or in association with other congenital or acquired conditions. Patients with TM typically present non-specific respiratory symptoms, ranging from noisy breathing with a typical barking cough to respiratory distress episodes to acute life-threatening events and recurrent and/or prolonged respiratory infections. There are no definitive standardized guidelines for the evaluation, diagnosis, and treatment of TBM; therefore, patients may be initially misdiagnosed and incorrectly treated. Although milder cases of TBM may become asymptomatic as the diameter of the airway enlarges with the child, in cases of severe TBM, more aggressive management is warranted. This article is an overview of the clinical presentation, evaluation, diagnosis, medical management, and surgical treatment options in pediatric tracheomalacia.
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Affiliation(s)
- Ali Kamran
- Department of General Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | - Russell W Jennings
- Department of General Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
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10
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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
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11
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Arcieri L, Giordano R, Murzi B. To do or not to do? The management dilemma of congenital tracheal stenosis in the setting of the ring-sling complex. J Thorac Dis 2017; 9:4896-4898. [PMID: 29312686 DOI: 10.21037/jtd.2017.11.79] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Luigi Arcieri
- Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Raffaele Giordano
- Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Bruno Murzi
- Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
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12
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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
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13
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Ing RJ. Anesthetic Outcomes in Tetralogy of Fallot With Absent Pulmonary Valve. J Cardiothorac Vasc Anesth 2017; 31:922-923. [PMID: 28465119 DOI: 10.1053/j.jvca.2017.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Richard J Ing
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
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