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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.
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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.
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Razumovsky AY, Stepanenko NS, Kulikova NV, Kislenko AA. [Thoracoscopic tracheal resection in a child under extracorporeal membrane oxygenation]. Khirurgiia (Mosk) 2024:86-90. [PMID: 38258693 DOI: 10.17116/hirurgia202401186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Congenital tracheal stenosis in children is a rare, severe and life-threatening respiratory tract malformation characterized by respiratory failure. We have performed 74 surgical interventions in these patients under extracorporeal membrane oxygenation between 2013 and 2022. In this article, we present surgical treatment of a newborn with congenital tracheal stenosis. For the first time in the world, the patient underwent thoracoscopic resection and reconstruction of the trachea under extracorporeal membrane oxygenation.
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Affiliation(s)
- A Yu Razumovsky
- Pirogov Russian National Research Medical University, Moscow, Russia
- Children's City Clinical Hospital named after N.F. Filatov, Moscow, Russia
| | - N S Stepanenko
- Pirogov Russian National Research Medical University, Moscow, Russia
- Children's City Clinical Hospital named after N.F. Filatov, Moscow, Russia
| | - N V Kulikova
- Children's City Clinical Hospital named after N.F. Filatov, Moscow, Russia
| | - A A Kislenko
- Pirogov Russian National Research Medical University, Moscow, Russia
- Children's City Clinical Hospital named after N.F. Filatov, Moscow, Russia
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3
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Sidell DR, Meister KD, de Alarcon A, Boudewyns A, Brigger M, Chun R, Fayoux P, Goudy S, Hart CK, Hewitt R, Hsu WC, Javia LR, Johnson RF, Messner AH, Moreddu E, Nicollas R, Prager JD, Rahbar R, Rickert S, Rossi ME, Russell J, Rutter M, Sandu K, Smith RJH, Soma M, Thierry B, Trozzi M, White DR, Balakrishnan K. International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Evaluation and management of congenital tracheal stenosis. Int J Pediatr Otorhinolaryngol 2022; 161:111251. [PMID: 35988373 DOI: 10.1016/j.ijporl.2022.111251] [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: 04/02/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To outline an expert-based consensus of recommendations for the diagnosis and management of pediatric patients with congenital tracheal stenosis. METHODS Expert opinions were sought from members of the International Pediatric Otolaryngology Group (IPOG) via completion of an 18-item survey utilizing an iterative Delphi method and review of the literature. RESULTS Forty-three members completed the survey providing recommendations regarding the initial history, clinical evaluation, diagnostic evaluation, temporizing measures, definitive repair, and post-repair care of children with congenital tracheal stenosis. CONCLUSION These recommendations are intended to be used to support clinical decision-making regarding the evaluation and management of children with congenital tracheal stenosis. Responses highlight the diverse management strategies and the importance of a multidisciplinary approach to care of these patients.
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Affiliation(s)
- Douglas R Sidell
- Stanford Children's Health Aerodigestive and Airway Reconstruction Program and Stanford University, Stanford, CA, USA
| | - Kara D Meister
- Stanford Children's Health Aerodigestive and Airway Reconstruction Program and Stanford University, Stanford, CA, USA
| | | | - An Boudewyns
- Antwerp University Hospital, University of Antwerp, Belgium
| | - Matthew Brigger
- Rady Children's Hospital and University of California San Diego, San DIego, CA, USA
| | - Robert Chun
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Steven Goudy
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Catherine K Hart
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Wei-Chung Hsu
- National Taiwan University Hospital and Children's Hospital, Taiwan
| | - Luv R Javia
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Eric Moreddu
- Dept of Pediatric Otolaryngology Head and Neck Surgery, Hôpital La Timone Enfants, Marseille, France
| | - Richard Nicollas
- Dept of Pediatric Otolaryngology Head and Neck Surgery, Hôpital La Timone Enfants, Marseille, France
| | - Jeremy D Prager
- Children's Hospital Colorado, University of Colorado, Denver, CO, USA
| | | | | | | | - John Russell
- Children's Health Ireland (Crumlin), Trinity College Dublin, Dublin, Ireland
| | - Michael Rutter
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kishore Sandu
- Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | | | - Marlene Soma
- Sydney Children's Hospital, Edgecliff, NSW, Australia
| | - Briac Thierry
- Necker Enfants Malades Hospital - Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - David R White
- Medical University of South Carolina, Charleston, SC, USA
| | - Karthik Balakrishnan
- Stanford Children's Health Aerodigestive and Airway Reconstruction Program and Stanford University, Stanford, CA, USA.
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4
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Wu X, Chen J, Iroegbu CD, Liu J, Wu M, Xie X, Xiang K, Wu X, Chen W, Huang P, Zhou W, Fan C, Yang J. Individualized Analysis and Treatment of Difficult Weaning From Ventilation Following Open Cardiac Surgery in Young Children With Congenital Heart Disease. Front Cardiovasc Med 2022; 9:768904. [PMID: 35722090 PMCID: PMC9198256 DOI: 10.3389/fcvm.2022.768904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
AimsThe study explores the leading causes of postoperative extubation difficulties in pediatric patients (neonates and toddlers) with congenital heart diseases and establishes individualized treatment for different reasons.MethodWe retrospectively analyzed medical records of 4,971 pediatric patients with congenital heart defects treated in three tertiary Congenital Heart Disease Centres in China from January 2005 to December 2020, from whom we selected those with difficulty extubation but successful weaning during the postoperative period. Next, we performed an analysis of risk factors and reported the combined experience of individualized treatment for successful extubation.ResultsSeventy-five pediatric patients were identified in our database, among whom 23 had airway stenosis, 17 had diaphragmatic dysfunction, and 35 had pulmonary infection. The patients were all successfully weaned from the ventilator after an individualized treatment plan. In addition, the intubation time in the airway stenosis group was 17.7 ± 9.0, 33.6 ± 13.9 days in the diaphragmatic dysfunction group, and 11.9 ± 3.8 days in the pulmonary infection group.ConclusionGiven the primary reasons for difficult weaning following open-heart surgery in pediatric patients with congenital heart diseases, an individualized treatment scheme can achieve the ideal therapeutic effect where patients can be weaned faster with a shorter intubation period.
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Affiliation(s)
- Xiaoming Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jinlan Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chukwuemeka Daniel Iroegbu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jian Liu
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, Changsha, China
| | - Ming Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of the Cardiovascular Surgery of the Hunan Provincial People's Hospital, Changsha, China
| | - Xia Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Kun Xiang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xun Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wangping Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Peng Huang
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, Changsha, China
| | - Wenwu Zhou
- Department of the Cardiovascular Surgery of the Hunan Provincial People's Hospital, Changsha, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Chengming Fan
| | - Jinfu Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
- Jinfu Yang
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Shen X, Tan W, Jia B, Ye M. Relationship between a Tracheal and Left Pulmonary Artery Stenosis Index and the Prognosis of Pulmonary Artery Sling with Tracheal Stenosis. Pediatr Cardiol 2021; 42:1585-1593. [PMID: 34046721 DOI: 10.1007/s00246-021-02643-9] [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: 06/19/2020] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
Pulmonary artery sling is a rare congenital pulmonary vascular malformation, often associated with tracheal or bronchial stenosis. Surgical treatment of pulmonary artery sling with tracheal stenosis (T) has a high risk of death and a relatively poor prognosis. This study explored the relationship between the T and left pulmonary artery stenosis (P) ratio and the effects of surgery for pulmonary artery sling with tracheal stenosis. Patients undergoing surgery for pulmonary artery sling in our center from January 2010 to December 2018 were retrospectively analyzed. Routine cardiac-enhanced computed tomography (CT) was performed preoperatively, and the P and T diameters were measured on the CT image. The T/P ratio was then calculated and analyzed. Thirty cases of pulmonary artery sling combined with tracheal stenosis were operated under cardiopulmonary bypass. The mean age at operation was 13.8 ± 13.6 months (1.2-57.1 months, Q1-Q3: 5-17 months), and the mean body weight was 8.8 ± 3.5 kg (3.8-17.3 kg, Q1-Q3: 5.8-11.5 kg). Twenty-three patients survived, and seven died, with an overall survival rate of 76.7%. Twenty-four patients underwent left pulmonary artery re-implantation, six patients underwent simultaneous left pulmonary artery re-implantation and slide tracheoplasty, and patients with intracardiac malformations (ventricular septal defect (n = 6) and atrial septal defect (n = 4)) underwent concurrent repair of the intracardiac defect. All cases had different degrees of tracheal stenosis, and the most narrowed trachea occurred with compression by the left pulmonary artery sling. The T/P ratio in the tracheoplasty group was significantly higher than that in the non-tracheoplasty group. The mortality rate in the T/P ≤ 1.15 group was significantly lower than that in the T/P > 1.15 group. Pulmonary artery sling treatment has a high risk of death. Left pulmonary artery re-implantation is an effective and safe surgical method for treating pulmonary artery sling, and slide tracheoplasty is an effective surgical method to correct tracheal stenosis. Children with T > 78.4% should receive active intervention for the tracheal stenosis, and these children have a considerable postoperative survival rate. The T/P ratio can be used to compare the relative superiority of the two compressions. A T/P ratio > 1.15 can be used as a reference index for intervention in tracheal stenosis and is a risk factor for postoperative death.
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Affiliation(s)
- Xiao Shen
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - WeiQiang Tan
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Bing Jia
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ming Ye
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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Riggs KW, Wells D, Zafar F, Morales DLS, Bryant R, Tweddell JS. Risk of Pediatric Cardiac Surgery Increased in Patients Undergoing Tracheal Surgery During the Same Hospitalization. World J Pediatr Congenit Heart Surg 2021; 12:730-736. [PMID: 34424089 DOI: 10.1177/21501351211037624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The impact of complex tracheal surgery (TS) on outcomes of children undergoing cardiac surgery has rarely been investigated in large national databases and could impact anticipated outcomes in those patients. METHODS The Pediatric Health Information System database was reviewed from January 1, 2005 to December 31, 2014, for pediatric (<18 years) patients undergoing select cardiac surgical procedures using International Classification of Disease-9 procedural coding. Patients were divided based upon having TS (excluding tracheostomy) during the same hospitalization. Patients with tracheal and cardiac surgeries (CHS + TS) were propensity matched in a 1 : 2 fashion to patients undergoing isolated cardiac surgeries without TS (CHS) based upon cardiac procedure(s), age at surgery, gender, and discharge year. Hospital mortality and other outcomes were compared between the 2 matched groups. RESULTS The 283 CHS + TS patients were similar to the 566 CHS patients in gender, race, age, cardiac procedures, and presence of chromosomal abnormalities, all P > .05. Hospital mortality was 13.8% (n = 39) for CHS + TS and 5.8% (n = 33) for CHS patients with an unadjusted 2.58 hazard ratio of death (95% confidence interval: 1.59-4.20; P < .001). CHS + TS was also associated with a greater length of stay (63 days vs 12 days), a higher cost per hospitalization ($322 402 vs $80 273), and more readmissions (64.3% [n = 182] vs 41.8% [n = 243]), all P < .001. CONCLUSIONS Patients undergoing cardiac and TS in the same hospitalization are at greater risk of in-hospital mortality than patients undergoing similar cardiac surgeries alone and incur higher resource utilization thereafter. The increased risk of mortality is currently underappreciated, but it is important to recognize when discussing expectations with families and providers.
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Affiliation(s)
- Kyle W Riggs
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Northwell Health, Manhasset, NY, USA
| | - Dennis Wells
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
| | - Farhan Zafar
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
| | - David L S Morales
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
| | | | - James S Tweddell
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
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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.
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8
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Tracheoplasty for Patients with Pulmonary Artery Sling and Tracheal Stenosis: A Meta-Analysis. Pediatr Cardiol 2020; 41:1376-1385. [PMID: 32494877 DOI: 10.1007/s00246-020-02386-z] [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: 03/03/2020] [Accepted: 05/23/2020] [Indexed: 02/05/2023]
Abstract
We performed this meta-analysis to assess the safety and efficacy of tracheoplasty for patients with pulmonary artery sling (PAS) and tracheal stenosis. Published studies that included surgical treatment of PAS and tracheal stenosis with and without tracheoplasty were identified by searching the PubMed, EMBASE, and Cochrane Library databases until May 2020. The outcomes assessed included postoperative ventilation time, early and late mortality, and follow-up respiratory symptoms. The mean difference (MD)/risk ratio (RR) with 95% confidence intervals (CI) was estimated with a random-effects/fixed-effects model. Subgroup analysis was performed stratified by percentage of patients with tracheal rings. A total of eight studies comprising 219 patients with PAS accompanied by tracheal stenosis were included. The pooled estimates of postoperative ventilation time (MD 17.68, 95% CI 6.38 to 28.98, p < 0.01) and early mortality (RR 3.93, 95% CI 1.55 to 9.95, p < 0.01) favored the repair-only group. Late mortality (RR 1.33, 95% CI 0.48 to 3.68, p = 0.58) and respiratory symptoms (RR 1.51, 95% CI 0.50 to 4.57, p = 0.47) at follow-up showed no significant differences between the groups with repair-only and repair with tracheoplasty. The same results were found in subgroup analyses. For the surgical treatment of PAS with tracheal stenosis, repair without tracheoplasty appears to result in shorter postoperative ventilation time and lower early mortality, with no increase in late mortality or respiratory symptoms at follow-up, compared with concomitant tracheoplasty.
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9
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Houska N, Twite MD, Ing RJ. The Importance of the Airway in Children Undergoing Surgery for Congenital Heart Disease. J Cardiothorac Vasc Anesth 2020; 35:145-147. [PMID: 33004270 DOI: 10.1053/j.jvca.2020.09.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Nicholas Houska
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Mark D Twite
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Richard J Ing
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
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10
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Switch to Extracorporeal Membrane Oxygenation During Cardiac and Tracheal Repair. Ann Thorac Surg 2020; 110:e181-e183. [PMID: 32119857 DOI: 10.1016/j.athoracsur.2020.01.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/11/2020] [Accepted: 01/14/2020] [Indexed: 11/23/2022]
Abstract
Simultaneous repair of congenital tracheal and cardiovascular lesions remains challenging in small patients. We describe two infants weighing less than 3 kg who underwent successful tracheoplasty with concomitant correction of complex heart anomalies. In both operations, cardiopulmonary bypass was switched to extracorporeal membrane oxygenation after cardiac repair to optimize hemostatic function with transfusion and maintain activated clotting time at 200 to 240 seconds. Slide tracheoplasty was performed in a bloodless field, which prevented intraoperative hemorrhage from running down the divided lower trachea into the lung and causing airway obstruction. Both patients were weaned from extracorporeal support during surgery and extubated within 9 days.
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11
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Sengupta A, Murthy RA. Congenital tracheal stenosis & associated cardiac anomalies: operative management & techniques. J Thorac Dis 2020; 12:1184-1193. [PMID: 32274199 PMCID: PMC7139091 DOI: 10.21037/jtd.2019.10.42] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital tracheal stenosis can lead to symptomatic airway obstruction in children and often mandates surgical correction. Over the past half-century, numerous tracheal reconstruction techniques have been developed, including tracheal resection with end-to-end anastomosis (for short-segment complete tracheal stenosis), patch tracheoplasty, slide tracheoplasty, and homograft and autograft augmentation repairs. However, operative management of congenital tracheal stenosis is often complicated by the presence of congenital heart disease, the most common of which is pulmonary artery sling. When present concomitantly, combined repair of both defects is feasible and is currently the preferred approach. Questions have been raised about the optimal timing and sequence of surgery, and some have advocated staged repair for patients with complex associated cardiac lesions. However, evidence from the past two decades suggests that concomitant repair can be performed with excellent results. The current standard of care involves the use of cardiopulmonary bypass to simultaneously repair the tracheal defect using slide tracheoplasty and all associated cardiac anomalies. Advances in operative techniques and extracorporeal circulation, progressive understanding of the pathological basis of combined congenital tracheal and cardiac disease, and a multidisciplinary approach to patient care have all contributed to the successful outcomes seen in the modern era. This article describes the combined surgical correction of tracheal stenosis and double-outlet right ventricle-tetralogy of Fallot type in an infant, provides a detailed step-by-step description for performing a slide tracheoplasty along with various other less favored tracheoplasty techniques, and reviews the current literature discussing such combined repairs.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raghav A Murthy
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Fukushima N, Shimojima N, Ishitate M, Miyakawa T, Hirobe S, Miura M. Clinical and structural aspects of tracheal stenosis and a novel embryological hypothesis of left pulmonary artery sling. Pediatr Pulmonol 2020; 55:747-753. [PMID: 31975532 DOI: 10.1002/ppul.24661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/10/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To identify the imaging features peculiar to congenital tracheal stenosis (CTS) complicated with left pulmonary artery sling (LPAS) with the aim of presenting a hypothesis of tracheal stenosis embryology in LPAS. METHODS We retrospectively reviewed CTS patients (with complete cartilaginous rings) admitted between April 2010 and July 2018. All the patients were classified into the LPAS or non-LPAS group, and their clinical characteristics and qualitative variables on computed tomography (CT) imaging were compared. RESULTS Of the 72 patients enrolled, 61 had bilateral lungs. Among the bilateral lung patients, 26 (43%) had LPAS. The tracheal bifurcation was significantly deeper, the stenotic region was longer, and the bronchial angle (especially in the right) was wider, in the LPAS group. The cut-off values for the thoracic vertebral level at the tracheal bifurcation (>4.8), subcarinal angle (>118.1), and right bronchial angle (>61.9) were useful for diagnosing suspected cases of LPAS. In the time-dependent course, LPAS complicated with a congenital heart defect was a statistically significant risk factor of respiratory symptoms (hazard ratio, 3.01; 95% confidence interval, 1.23-7.37; P = .02). CONCLUSIONS The CT findings described here should immediately raise suspicion of LPAS on chest X-ray and also suggest tracheal "squeezing and milking" by the surrounding vessels in the embryo. Patients with LPAS complicated with a heart defect should be followed carefully to determine the optimal timing of intervention.
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Affiliation(s)
- Naoya Fukushima
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan.,Department of Pediatrics, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan
| | - Naoki Shimojima
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan
| | - Makoto Ishitate
- Department of Respiratory Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan
| | - Tomoo Miyakawa
- Department of Respiratory Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan
| | - Seiichi Hirobe
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan
| | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan
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13
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Outcome of congenital tracheal stenosis in children over two decades in a national cardiothoracic surgical unit. Cardiol Young 2020; 30:34-38. [PMID: 31744583 DOI: 10.1017/s1047951119002725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the outcomes of congenital tracheal stenosis among children. MATERIALS AND METHODS A retrospective review of all children who underwent surgical repair of congenital tracheal stenosis reviewing charts, operative notes, echocardiograms, CT and MRI data from January 2002 to February 2019. RESULTS Twenty-six children underwent surgical treatment for tracheal stenosis. The median age was 3 months (range 0.3-35 months) and the median weight was 4.7 kg (range 2.5-13 kg) at the time of surgical intervention. Stridor was the most common presenting symptom in 17 patients (65% of patients). Twenty-one patients (81%) had concurrent cardiac anomalies, with pulmonary arterial sling being the most common, present in nine patients (34%). Extracorporeal life support was utilised in seven patients (27%) pre-operatively. Laryngeal release was required in 16 patients. In 7 patients an end-to-end anastomosis was performed, in 18 patients slide tracheoplasty, and 1 patient had a double slide tracheoplasty. The median cardiopulmonary bypass time was 106 minutes (range 25-255 minutes). The median cross-clamp time was 30 minutes (range 5-67 minutes). The median post-operative duration of ventilation was 5 days (range 0.5-16 days). The median ICU length of stay was 12.5 days (range 2-60 days). There were three hospital mortalities with 88% survival. One patient only required reintervention with balloon dilation. Twenty-two patients (85%) remained symptom-free on median follow-up at 7.6 years (range 0.2-17 years). Two patients since 2017 had 3D printed tracheas produced from CT imaging to assist surgical planning. CONCLUSION Congenital tracheal stenosis can be managed effectively with excellent outcomes and 3D printed models assist in planning the optimal surgical intervention.
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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.
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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.
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Clinical outcomes after tracheoplasty in patients with congenital tracheal stenosis in 1997-2014. J Pediatr Surg 2018; 53:2140-2144. [PMID: 29370890 DOI: 10.1016/j.jpedsurg.2017.12.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/15/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mortality and morbidity of congenital tracheal stenosis (CTS) remain high. The aim of this study was to determine the factors predicting 12-month survival and 2-month successful extubation after tracheoplasty in patients with CTS. METHODS Retrospective chart reviews were conducted in patients with CTS undergoing tracheoplasty at a single institution between 1997 and 2014. Patients' characteristics at disease onset and tracheoplasty were summarized. Twelve-month survival rate and 2-month extubation rate without tracheotomy after tracheoplasty were analyzed. RESULTS We reviewed 81 patients' records. Multivariate analysis for 12-month survival revealed that older age (>2 months, hazard ratio [HR]: 0.08, 95% confidence interval [CI]: 0.02-0.36) or heavier body weight (>4.4 kg, HR: 0.13, 95% CI: 0.02-0.73) at tracheoplasty was a predictive factor for survival. Body weight at tracheoplasty (>8.2 kg, HR: 3.83, 95% CI: 1.88-7.79), preoperative balloon dilatation (HR: 0.30, 95% CI: 0.12-0.78), and carina involvement (HR: 0.36, 95% CI: 0.19-0.69) were predictive factors for successful extubation. CONCLUSIONS Although CTS management is individualized, age or body weight at tracheoplasty needs to be considered and assessed for survival, as well as preoperative balloon dilatation, and carina involvement for successful extubation. LEVELS OF EVIDENCE Level III.
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Yokoi A. Congenital tracheal stenosis: what should we look at for successful tracheoplasty? Transl Pediatr 2018; 7:229-232. [PMID: 30159250 PMCID: PMC6087833 DOI: 10.21037/tp.2018.07.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
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Resheidat A, Kelly T, Mossad E. Incidental Diagnosis of Congenital Tracheal Stenosis in Children With Congenital Heart Disease Presenting for Cardiac Surgery. J Cardiothorac Vasc Anesth 2018; 33:781-784. [PMID: 29753667 DOI: 10.1053/j.jvca.2018.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Ashraf Resheidat
- Department of Pediatric Anesthesia, Baylor College of Medicine, Houston, TX
| | - Tamra Kelly
- Department of Pediatric Anesthesia, Baylor College of Medicine, Houston, TX
| | - Emad Mossad
- Department of Pediatric Anesthesia, Baylor College of Medicine, Houston, TX.
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Chatzis AC, Sofianidou J, Kousi T, Karapanagiotou O, Kanakis MA. Rare multiple bronchial abnormalities in a patient with congenital heart disease. Clin Case Rep 2017; 5:727-728. [PMID: 28469887 PMCID: PMC5412831 DOI: 10.1002/ccr3.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/25/2017] [Accepted: 02/26/2017] [Indexed: 11/12/2022] Open
Abstract
Although many variations regarding lobar or segmental bronchial subdivisions have been described, abnormal bronchi originating from the trachea or main bronchi are relatively rare. These abnormalities can remain undetectable as they usually do not present with symptoms; however, they may pose major obstacles during surgery especially when accompanied by bronchial wall abnormalities.
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Affiliation(s)
- Andrew C Chatzis
- Department of Paediatric and Congenital Cardiac Surgery Onassis Cardiac Surgery Centre Athens Greece
| | - Joanne Sofianidou
- Department of Anaesthesia Onassis Cardiac Surgery Centre Athens Greece
| | - Theofili Kousi
- Department of Anaesthesia Onassis Cardiac Surgery Centre Athens Greece
| | | | - Meletios A Kanakis
- Department of Paediatric and Congenital Cardiac Surgery Onassis Cardiac Surgery Centre Athens Greece
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Weber A, Donner B, Perez MH, Di Bernardo S, Trachsel D, Sandu K, Sekarski N. Complicated Postoperative Course after Pulmonary Artery Sling Repair and Slide Tracheoplasty. Front Pediatr 2017; 5:67. [PMID: 28443268 PMCID: PMC5385459 DOI: 10.3389/fped.2017.00067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
Pulmonary artery sling (PAS) is a rare congenital condition in which the left pulmonary artery (LPA) arises from the right pulmonary artery, and then passes between the trachea and the esophagus to reach the left lung, thereby forming a sling around the airway. It is often associated with intrinsic tracheal stenosis due to complete cartilaginous rings. Therapeutic management nowadays consists of one-stage reimplantation of the LPA and tracheoplasty with cardiopulmonary bypass support. Here, we present a 7-week-old boy with PAS and long-segment tracheal stenosis (LSTS) who underwent surgical intervention consisting of reimplantation of the LPA and slide tracheoplasty. Multiple respiratory and cardiovascular complications marked the postoperative course. They consisted of recurrent failed attempts in weaning off mechanical ventilation due to bronchomalacia, left vocal cord paralysis, development of granulation tissue at the anastomosis and restenosis of the trachea, and the main stem bronchi requiring balloon dilatation. The patient also developed bilateral pulmonary artery thrombosis and stenosis of the LPA. After a prolonged hospitalization, the patient is doing well without any respiratory symptoms and has a good result on follow-up bronchoscopy 1 year after the initial surgery. The stenosis of the LPA responded well to percutaneous balloon dilatation 12 months after the primary surgery. The case illustrates that even though surgical techniques are improving and are in general associated with a low morbidity and mortality, management of PAS and tracheal stenosis can still be challenging. However, good long-term outcome can be achieved if the initial postoperative phase is overcome.
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Affiliation(s)
- Angelika Weber
- Pediatric Cardiology Unit, Department of Pediatrics and Pediatric Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Birgit Donner
- Division of Pediatric Cardiology, University Children's Hospital Basel, Basel, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Stefano Di Bernardo
- Pediatric Cardiology Unit, Department of Pediatrics and Pediatric Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Daniel Trachsel
- Division of Pediatric Pulmonology, University Children's Hospital Basel, Basel, Switzerland
| | - Kishore Sandu
- Airway Unit, Service of Otorhinolaryngology, University Hospital Lausanne, Lausanne, Switzerland
| | - Nicole Sekarski
- Pediatric Cardiology Unit, Department of Pediatrics and Pediatric Surgery, University Hospital Lausanne, Lausanne, Switzerland
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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]
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Wang S, Zhang H, Zhu L, Zhen J, Liu J, Xu Z. Surgical management of congenital tracheal stenosis associated with tracheal bronchus and congenital heart disease. Eur J Cardiothorac Surg 2015; 49:1201-6. [DOI: 10.1093/ejcts/ezv317] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/12/2015] [Indexed: 11/13/2022] Open
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Abstract
Congenital cardiac anesthesiology is a rapidly expanding field at both ends of the life spectrum. The care of the unborn child with congenital heart disease is becoming highly specialized in regional centers that offer advanced imaging techniques, coordinated specialist care, and potentially fetal interventions. As more children with congenital heart disease survive to adulthood, patients and their health care providers are facing new challenges. The growing volume of publications reflects this expanding field of congenital cardiac anesthesiology. This year in review article highlights some developing trends in the literature.
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