Airway Compression or Airway Anomaly Causing Respiratory Symptoms in Infants and Children with Cardiovascular Diseases / 소아과

PURPOSE: Infants and children with cardiovascular diseases often present with respiratory symptoms. However, missed or delayed evaluation for potential airway problem may complicate overall prognosis. The aim of this study is to determine the clinical characteristics of these patients and explore the cause of airway problem. METHODS: We reviewed the medical records of 64 patients (M: F=33: 31, mean age: 6.3+/-7.5 months) whose airway problems were proven by computed tomography or bronchoscopy in perioperative periods at the Asan Medical Center from January 1997 to June 2004. Patients were divided into two groups based on the duration of ventilator care: 7 days (group 2: 41 cases, M: F=23: 18). RESULTS: The patients in group 2 significantly developed more post-operative respiratory symptoms than group 1 (P< 0.001) and had more airway problems including extrinsic obstruction, intrinsic anomaly, and combined problem than group 1 although not significantly different (P=0.082). Among underlying diseases, the most common diseases were vascular anomaly (26.2 percent) and aortic arch anomaly (26.2 percent) in group 1 and pulmonary atresia with ventricular septal defect (22.4 percent) in group 2. The most frequent respiratory symptoms were recurrent wheezing pre-operatively and failure of ventilator weaning post-operatively. The major types of airway anomaly were tracheomalacia and tracheal stenosis (in each case 18.2 percent). Nineteen patients with persistent airway problems underwent aortopexy or other vascular correction. Of the 19 patients, 13 (68.4 percent) were improved, but 2 failed in weaning ventilator and 4 died of non-airway problems. CONCLUSION: Early evaluation and treatment for potential airway problems may affect natural or surgical prognosis in patients with cardiovascular diseases presenting with respiratory symptoms.

In the face of a compromised airway

OBJECTIVES: This case report aims to (1) Present the differential diagnosis of chronic cough without neglecting uncommon causes (2) Increase awareness of diagnostic challenges that may arise in the face of a compromised airway (3) Elucidate the therapeutic complexity of airway management; (4) Emphasize the value of a multi-disciplinary team approach in such cases; Illustrate the vital role otolaryngologists play in the diagnosis and management of airway problems DESIGN: Case Report SETTING: Tertiary Care Hospital in Quezon City, Philippines PATIENTS: One Patient RESULTS: This is the case of an eleven-year old male that presented with chronic cough that was refractory to conventional empiric medical therapy. As his symptoms progressed, further evaluation revealed a mass that was obstructing a large portion of the airway. Timely and methodical investigation and intervention proved to be life-saving. CONCLUSION: A working knowledge of the differential diagnoses of chronic cough is crucial in the diagnosis and management of the compromised airway. A high index of suspicion, systematic and thorough investigation and a multi-disciplinary approach are vital components of the treatment plan. Bronchoscopy in the hands of a skilled practitioner is still a diagnostic and therapeutic mainstay. (Author)