Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-23T00:40:17.516Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcome of congenital tracheal stenosis in children over two decades in a national cardiothoracic surgical unit

Published online by Cambridge University Press:  20 November 2019

Colin J. McMahon Open the ORCID record for Colin J. McMahon [Opens in a new window] ,
Karim Ayoubi ,
Rania Mehanna ,
Eithne Phelan ,
Eoin O’Cearbhaill Open the ORCID record for Eoin O’Cearbhaill [Opens in a new window] ,
John Russell  and
Lars Nölke
Colin J. McMahon*
Affiliation:
Department of Paediatric Cardiology, Our Lady’s Hospital for Sick Children, Crumlin, Dublin, Ireland School of Medicine, University College Dublin, Belfield, Dublin, Ireland
Karim Ayoubi
Affiliation:
Department of Cardiothoracic Surgery, Our Lady’s Hospital for Sick Children, Crumlin, Dublin, Ireland
Rania Mehanna
Affiliation:
Department of Otolaryngology, Our Lady’s Hospital for Sick Children, Crumlin, Dublin, Ireland
Eithne Phelan
Affiliation:
Department of Radiology, Our Lady’s Hospital for Sick Children, Crumlin, Dublin, Ireland
Eoin O’Cearbhaill
Affiliation:
UCD Centre for Biomedical Engineering and School of Mechanical & Materials Engineering, University College Dublin, Belfield, Dublin, Ireland
John Russell
Affiliation:
Department of Otolaryngology, Our Lady’s Hospital for Sick Children, Crumlin, Dublin, Ireland
Lars Nölke
Affiliation:
Department of Cardiothoracic Surgery, Our Lady’s Hospital for Sick Children, Crumlin, Dublin, Ireland
*
Author for correspondence: Prof. C. J. McMahon, Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland. Tel: 01-4282854; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Tracheal stenosiscongenitalheart defectslide tracheoplastysurgery3D printing
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 1 , January 2020 , pp. 34 - 38
Copyright
© Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anton-Pacheco, JL, Cano, I, Comas, J, et al.Management of congenital tracheal stenosis in infancy. Eur J Cardiothorac Surg 2006; 29: 991–996.CrossRefGoogle ScholarPubMed
Chiu, PP, Kim, PC. Prognostic factors in the surgical treatment of congenital tracheal stenosis: a multicenter analysis of the literature. J Pediatr Surg 2006; 41: 221–225.CrossRefGoogle Scholar
Butler, CR, Speggiorin, SS, Rijnberg, FM, et al.Outcomes of slide tracheoplasty in 101 children: a 17-year single centre experience. J Thor Cardiovasc Surg 2014; 147: 1783–1790.CrossRefGoogle Scholar
Grillo, HC, Wright, CD, Vlahakes, GJ, Mac Gillivray, TE. Management of congenital tracheal stenosis by means of a slide tracheoplasty or resection and reconstruction with long-term follow up of growth after slide tracheoplasty. J Thorac Cardiovasc Surg 2002; 143: 144–151.Google Scholar
Backer, CL, Mavroudis, C, Gerber, ME, Holinger, LD. Tracheal surgery in children: an 18-year review of four techniques. Eur J Cardiothorac Surg 2001; 19: 777–784.CrossRefGoogle ScholarPubMed
Loeff, DS, Filler, RM, Vinograd, I, et al.Congenital tracheal stenosis: a review of 22 patients from 1965 to 1987. J Pediatr Surg 1988; 23: 744–748.CrossRefGoogle ScholarPubMed
Elliot, M, Hartley, BE, Wallis, C, Roebuck, D. Slide tracheoplasty. Curr Opin Otolaryngol Head Neck Surg 2008; 16: 75–82.CrossRefGoogle Scholar
Manning, PB, Rutter, MJ, Lisce, A, Gupta, R, Marino, BS. One slide fits all: the versatility of slide tracheoplasty with cardiopulmonary bypass support for airway reconstruction in children. J Thorac Cardiovasc Surg 2011; 141: 155–161.CrossRefGoogle ScholarPubMed
Zhang, H, Wang, S, Lu, Z, et al.Slide trcheoplasty in 81 children: improved outcome with modified surgical technique and optimal surgical age. Medicine (Baltimore) 2017; 96: e8013.CrossRefGoogle ScholarPubMed
Chung, CR, Yang, JH, Jun, TG, et al.Clinical outcomes of slide tracheoplasty in congenital tracheal stenosis. Eur J Cardiothorac Surg 2015; 47: 537–542.CrossRefGoogle ScholarPubMed
Arcieri, L, Giordano, R, Bellanti, E, Chappino, D, Murzi, B. Impact of 3D printing on the surgical management of tracheal stenosis associated to pulmonary sling: a case report. J Thorac Dis 2018; 10: E130–E133.CrossRefGoogle ScholarPubMed
Hong, X, Zhou, G, Liu, Y, Liu, Y, Wang, H, Feng, Z. Management of pulmonary artery sling with tracheal stenosis: LPA reimplantation without tracheoplasty. Int J Clin Exp Med 2015; 8: 2741–2747.Google Scholar
Xue, B, Liang, B, Wang, S, Zhu, L, Lu, Z, Xu, Z. One-stage surgical correction of congenital tracheal stenosis complicated with congenital heart disease in infants and young children. J Card Surg 2015; 30: 97–103.CrossRefGoogle ScholarPubMed
Wang, S, Zhang, H, Zhu, L, Zhen, J, Liu, J, Xu, Z. Surgical management of tracheal stenosis associated with tracheal bronchus and congenital heart disease. Eur J Cardiothorac Surg 2016; 49: 1201–1206.CrossRefGoogle ScholarPubMed
Barker, IR, McLaren, C, Stockton, E. The finding of an undiagnosed long segment tracheal stenosis in a cyanotic infant undergoing an arterial switch operation and VSD closure. BMJ Case Rep 2015; 201 5.Google Scholar
Kelleher, EM, Nolke, L, McMahon, CJ. Successful slide tracheoplasty and partial atrioventricular septal defect repair following extracorporeal membrane oxygenation. Cardiol Young 2015; 25: 573–575.CrossRefGoogle ScholarPubMed
Brink, J, d’Udekem, Y, Konstantinov, IE. Slide tracheoplasty with concomitant aortic arch repair in a low-weight neonate. Ann Thorac Surg 2014; 97: 1057–1059.CrossRefGoogle Scholar
Matsuhisa, H, Oshima, Y, Kadowaki, T, Yokoi, A. Simultaneous complex single ventricle palliation and tracheoplasty for heterotaxy syndrome. Interact Cardiovasc Thorac Surg 2012; 15: 523–524.CrossRefGoogle ScholarPubMed
Yong, MS, Harrison, J, Berkowitz, RG, Ranganathan, S, Konstantinov, IE. An approach to successful slide tracheoplasty in the low birth weight infant with single lung. Int J Pediatr Otorhinolaryngol 2018; 108: 80–81.CrossRefGoogle ScholarPubMed
Yokoi, A, Oshima, Y, Nishijima, E. The role of adjunctive procedures in reducing postoperative tracheobronchial obstruction in single lung patients with congenital tracheal stenosis undergoing slide tracheoplasty. J Pediatr Surg 2017; 52: 677–679.CrossRefGoogle ScholarPubMed
Martin, BJ, Holinski, P, Noga, M, El-Hakim, H, Aklabi, MA. Neonatal tracheal and intracardiac repair in a high-risk premature infant requiring preoperative ECMO transport. World J Pediatr Congenit Heart Surg 2019; 10: 380–383.CrossRefGoogle Scholar