Pediatric Cardiology and Cardiac Surgery
Vol.25 No.4 2009 (608-615)
Masatsugu Terada,1) Kentaro Hotoda,1) Sohshu Kotani,1) Naotaka Atsumi,1) Takashi Naganuma,2) Shino Chinen,2) Takuya Tamame,2) Megumi Matsuoka,2) Hirotaka Ooki,2) Masaru Miura,,2) and Masaaki Satoh2)
Departments of 1)Cardiovascular Surgery and 2)Cardiology, Tokyo Metropolitan Kiyose Children’s Hospital, Tokyo, Japan
Abstract
Background: Congenital tracheal stenosis (CTS) is a life-threatening disorder commonly associated with congenital cardiovascular malformations. The purpose of this study is to shed light on the surgical problems for the anomaly with a review for patients in our institution.
Methods: Subjects included 16 children with CTS who were consecutively treated by slide tracheoplasty from July 1998 to January 2008. Their clinical and morphological manifestations were retrospectively evaluated.
Results: Ages ranged from 2 to 40 months (median age, 5 months), and body weight from 2.2 to 12kg (average, 5.6kg). The narrowest tracheal diameter ranged from 2 to 4mm and the ratio of the length of the stenotic segment to the entire trachea from 40 to 80%. Fourteen patients (88%) were associated with cardiovascular anomalies, and 8 patients with PA sling. Eleven patients developed clinical symptoms within 2 months of life. Ten patients underwent simultaneous cardiovascular repair and tracheoplasty. Early mortality ensued in 4 patients (25%): the three were associated with severe cardiopulmonary anormalies, including AP window with PPHN, PA with MAPCA, VATER association with agenesis of the right lung, and the other with severe asphyxia requiring ECMO prior to slide tracheoplasty. We did not meet any surgical complications of the trachea itself, such as granulation tissue formation and restenosis. Late mortality was not encountered.
Conclusions: Slide tracheoplasty for CTS has provided satisfactory results. The final goal is to lessen mortality in patients with complicated cardiovascular and pulmonary anomalies.