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Assessment of airway abnormalities in patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals

Published online by Cambridge University Press:  02 May 2019

Lisa Wise-Faberowski ,
Matthew Irvin ,
Douglas R. Sidell ,
Sheila Rajashekara ,
Ritu Asija ,
Frandics P. Chan ,
Frank L. Hanley  and
Doff B. McElhinney
Lisa Wise-Faberowski*
Affiliation:
Department of Anesthesiology, Stanford University, Palo Alto, CA, USA
Matthew Irvin
Affiliation:
Clinical and Translational Research Program, Betty Moore heart Center, Palo Alto, CA, USA
Douglas R. Sidell
Affiliation:
Depatment of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
Sheila Rajashekara
Affiliation:
Department of Anesthesiology, Stanford University, Palo Alto, CA, USA
Ritu Asija
Affiliation:
Department of Pediatrics, Stanford University, Palo Alto, CA, USA
Frandics P. Chan
Affiliation:
Department of Radiology, Stanford University, Palo Alto, CA, USA
Frank L. Hanley
Affiliation:
Department of Cardiothoracic Surgery, Lucile Packard Children’s Hospital Heart Center, Stanford University, Palo Alto, CA, USA
Doff B. McElhinney
Affiliation:
Clinical and Translational Research Program, Betty Moore heart Center, Palo Alto, CA, USA Department of Pediatrics, Stanford University, Palo Alto, CA, USA Department of Cardiothoracic Surgery, Lucile Packard Children’s Hospital Heart Center, Stanford University, Palo Alto, CA, USA
*
Author for correspondence: Lisa Wise-Faberowski, MD, MS, Associate Professor, Department of Anesthesiology, Stanford University, 300 Pasteur Dr., Palo Alto, CA 94305. Tel: 650-723-5728; Fax: 650-725-8544; E-mail: [email protected]
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Abstract

Background:

Children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals (TOF/MAPCAs) are at risk for post-operative respiratory complications after undergoing unifocalisation surgery. Thus, we assessed and further defined the incidence of airway abnormalities in our series of over 500 children with TOF/MAPCAs as determined by direct laryngoscopy, chest computed tomography (CT), and/or bronchoscopy.

Methods:

The medical records of all patients with TOF/MAPCAs who underwent unifocalisation or pulmonary artery reconstruction surgery from March, 2002 to June, 2018 were reviewed. Anaesthesia records, peri-operative bronchoscopy, and/or chest CT reports were reviewed to assess for diagnoses of abnormal or difficult airway. Associations between chromosomal anomalies and airway abnormalities – difficult anaesthetic airway, bronchoscopy, and/or CT findings – were defined.

Results:

Of the 564 patients with TOF/MAPCAs who underwent unifocalisation or pulmonary artery reconstruction surgery at our institution, 211 (37%) had a documented chromosome 22q11 microdeletion and 28 (5%) had a difficult airway/intubation reported at the time of surgery. Chest CT and/or peri-operative bronchoscopy were performed in 234 (41%) of these patients. Abnormalities related to malacia or compression were common. In total 35 patients had both CT and bronchoscopy within 3 months of each other, with concordant findings in 32 (91%) and partially concordant findings in the other 3.

Conclusion:

This is the largest series of detailed airway findings (direct laryngoscopy, CT, and bronchoscopy) in TOF/MAPCAS patients. Although these findings are specific to an at-risk population for airway abnormalities, they support the utility of CT and /or bronchoscopy in detecting airway abnormalities in patients with TOF/MAPCAs.

Keywords

Tetralogy of Fallotmajor aortopulmonary collateralschromosome 22q11 deletionairwaybronchoscopycomputed tomography
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 5 , May 2019 , pp. 610 - 614
Copyright
© Cambridge University Press 2019 

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References

Jefferson, K, Rees, S, Somerville, J. Systemic arterial supply to the lungs in pulmonary atresia and its relation to pulmonary artery development. Br Heart J 1972; 34: 418–427.CrossRefGoogle ScholarPubMed
Ho, SY, Catani, G, Seo, J-W. Arterial supply to the lungs in tetralogy of Fallot with pulmonary atresia or critical pulmonary stenosis. Cardiol Young 1992; 2: 65–72.Google Scholar
Rossi, RN,Hislop, A, Anderson, RH, et al. Systemic-to-pulmonary blood supply in tetralogy of Fallot with pulmonary atresia. Cardiol Young 2002; 12: 373–388.CrossRefGoogle ScholarPubMed
Bauser-Heaton, H, Borquez, A, Han, B, et al. Programmatic approach to management of tetralogy of Fallot with major aortopulmonary collateral arteries: a 15-year experience with 458 patients. Circ Cardiovasc Interv 2017; 10: e004952.CrossRefGoogle ScholarPubMed
Malhotra, SP, Hanley, FL. Surgical management of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals: a protocol-based approach. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009; 12: 145–151.CrossRefGoogle Scholar
Reddy, VM, Liddicoat, JR, Hanley, FL. Midline one-stage complete unifocalization and repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. J Thorac Cardiovasc Surg 1995; 109: 832–845.CrossRefGoogle ScholarPubMed
McElhinney, DB, Reddy, VM, Hanley, FL. Tetralogy of Fallot with major aortopulmonary collaterals: early total repair. Pediatr Cardiol 1998; 19: 289–296.CrossRefGoogle ScholarPubMed
Sidell, DR, Koth, AM, Bauser-Heaton, H, et al. Bronchoscopy in children with tetralogy of fallot, pulmonary atresia and major aortopulmonary collaterals. Pediatr Pulm 2017; 9999: 1–6.CrossRefGoogle Scholar
Asija, R, Hanley, FL, Roth, SJ. Postoperative respiratory failure in children with tetralogy of fallot, pulmonary atresia, and major aortopulmonary collaterals: a pilot study. Pediatr Crit Care Med 2013; 14: 384–389.CrossRefGoogle ScholarPubMed
Asija, R, Roth, SJ, Hanley, FL, et al. Reperfusion pulmonary edema in children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries undergoing unifocalization procedures: a pilot study examining potential pathophysiologic mechanisms and clinical significance. J Thorac Cardiovasc Surg 2014; 148: 1560–1565.CrossRefGoogle ScholarPubMed
Perri, G, Albanese, SB, Carotti, A. Airway complications after single-stage unifocalization for pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. J Card Surg 2015; 30: 453–458.CrossRefGoogle ScholarPubMed
Kaneko, Y, Yoda, H, Tsuchiya, K. Airway compression by major aortopulmonary collaterals with 22q11 deletion. Asian Cardiovasc Thorac Ann 2007; 15: e9–e11.CrossRefGoogle ScholarPubMed
Carotti, A, Digilio, MC, Piacentini, G, et al. Cardiac defects and results of cardiac surgery in 22q11.2 deletion syndrome. Dev Disabil Res Rev 2008; 14: 35–42.CrossRefGoogle ScholarPubMed
Mainwaring, RD, Patrick, WL, Carrillo, SA, et al. Prevalence and anatomy of retroesophageal major aortopulmonary collateral arteries. Ann Thorac Surg 2016; 102:877–882.CrossRefGoogle ScholarPubMed
Mercer-Rosa, L, Pinto, N, Yang, W, et al. 22q11.2 Deletion syndrome is associated with perioperative outcome in tetralogy of Fallot. J Thorac Cardiovasc Surg 2013; 146: 868–873.CrossRefGoogle ScholarPubMed
O’Byrne, ML, Yang, W, Mercer-Rosa, L, et al. 22q11.2 Deletion syndrome is associated with increased perioperative events and more complicated postoperative course in infants undergoing infant operative correction of truncus arteriosus communis or interrupted aortic arch. J Thorac Cardiovasc Surg 2014; 148: 1597–605.CrossRefGoogle ScholarPubMed
Huang, RY, Shapiro, NL. Structural airway anomalies in patients with DiGeorge syndrome: a current review. Am J Otolaryngol 2000; 21: 326–330.CrossRefGoogle ScholarPubMed
Leopold, C, De Barros, A, Cellier, C, et al. Laryngeal abnormalities are frequent in the 22q11 deletion syndrome. Int J Pediatr Otorhinolaryngol 2012; 76: 36–40.CrossRefGoogle ScholarPubMed
Li, S, Zhang, Y, Li, S, Wang, X, et al. Risk factors associated with prolonged mechanical ventilation after corrective surgery for tetralogy of fallot. Congen Heart Dis 2015; 10: 254–262.CrossRefGoogle ScholarPubMed
Davis, DA, Tucker, JA, Russo, P. Management of airway obstruction in patients with congenital heart defects. Ann Otol Rhinol Laryngol 1993; 102: 163–166.CrossRefGoogle ScholarPubMed
Lee, YS, Jeng, MJ, Tsao, PC, et al. Prognosis and risk factors for congenital airway anomalies in children with congenital heart disease. PLOS One 2015; 10: e0137437.CrossRefGoogle ScholarPubMed
Kazim, R, Berdon, WE, Montoya, CH, et al. Tracheobronchial anomalies in children with congenital heart disease. J Cardiothorac Vasc Anesth 1998; 12: 553–555.CrossRefGoogle Scholar
Kazim, R, Quaegebeur, JM, Sun, LS. The association of tracheal anomalies and tetralogy of fallot. J Thorac Cardiovasc Surg 1996; 12: 553–555.Google Scholar
Ferencz, C, Correa-Villasenot, A, Loffredo, CA, et al. Congenital heart disease: a direct result of chromosomal duplication. Tetralogy 1999; 59: 3.Google ScholarPubMed
Harris, SE, Cronk, C, Cassidy, LD, et al. Exploring the environmental and genetic etiologies of congenital heart defects: the Wisconsin Pediatric Cardiac Registry. J Registry Manag 2011; 38: 24–29.Google ScholarPubMed
Marino, B, Digilio, MC, Grazioli, S, et al. Associated cardiac anomalies in isolated and syndromic patients with tetralogy of Fallot. Am J Cardiol 1996; 1: 505–508.CrossRefGoogle Scholar
Anacierio, S, Marino, B, Carotti, A, et al. Pulmonary atresia with ventricular septal defect: prevalence of deletion 22q11 in the different anatomic patterns. Ital Heart 2001; 2: 384–387.Google Scholar
McElhinney, DB, Driscoll, DA, Emanuel, BS, et al. Chromosome 22q11 deletion in patients with truncus arteriosus. Pediatr Cardiol 2003; 24: 569–573.CrossRefGoogle ScholarPubMed
Marino, B, Digilio, MC, Toscano, A, et al. Anatomic patterns of conotruncal defects associated with deletion 22q11. Genet Med 2001; 3: 45–48.CrossRefGoogle ScholarPubMed
McElhinney, DB, Clark, BJ, Weinberg, PM, et al. Association of chromosome 22q11 deletion with isolated anomalies of aortic arch laterality and branching. J Am Coll Cardiol 2001; 37: 2114–2119.CrossRefGoogle Scholar
Toscano, A, Anacierio, S, Digilio, MC, et al. Ventricular septal defect and deletion of chromosome 22q11: anatomical types and aortic arch anomalies. Eur J Pediatr 2002; 161: 116–117.CrossRefGoogle ScholarPubMed
Mercer-Rosa, L, Elci, OU, Pinto, NM, et al. 22q11.2 deletion status and perioperative outcomes for Tetralogy of Fallot with pulmonary atresia and multiple aortopulmonary collateral vessels. Pediatr Cardiol 2018; 39: 906–910.CrossRefGoogle ScholarPubMed
Sacca, R, Zur, KB, Crowley, TB, et al. Association of airway abnormalities with 22q11 deletion syndrome. Int J Pedaitr Otorhinolaryngo 2017; 96: 11–14.CrossRefGoogle Scholar
Cotts, T, Hirsch, J, Thorne, M, et al. Tracheostomy after pediatric cardiac surgery: frequency, indications and outcomes. J Thorac Cardiovasc Surg 2011; 141: 413–418.CrossRefGoogle ScholarPubMed
Heyer, CM, Nuesslein, TG, Jung, D, et al. Tracheobronchial anomalies and stenoses: detection with low-dose multidetector CT with virtual tracheobronchoscopy-comparison with flexible tracheobronchoscopy. Radiology 2017; 242: 542–549.CrossRefGoogle Scholar
Greenberg, SB, Dyamenahalli, U. Dynamic pulmonary computed tomography angiography: a new standard for evaluation of combined airway and vascular abnormalities in infants. Int J Cardiovasc Imaging 2014; 30: 407–414.CrossRefGoogle ScholarPubMed