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Resumen: Introducción: La pandemia por COVID-19 es una enfermedad de predominio respiratorio que ha afectado a nivel mundial y ha dejado más de 151 millones de casos, los cuales suelen requerir un manejo de ventilación mecánica con la intensión de controlar las vías aéreas superiores para la adecuada oxigenación de las personas con COVID-19, y que se reduzca así el riesgo de contagio para el personal médico. Objetivo: Describir el abordaje anestésico para la inducción y mantenimiento de una traqueoplastía derivado a estenosis traqueal secundaria por COVID-19. Material y métodos: Se aborda la descripción de un caso y los lineamientos que se han dado para el manejo de la estenosis traqueal. Conclusiones: El control oportuno anestésico y la instalación de férula laríngea son apropiados para el manejo de la estenosis traqueal secundaria al proceso de intubación mecánica prolongada por COVID-19.
Abstract: Introduction: The COVID-19 pandemic is a predominantly respiratory disease that has affected worldwide and has left more than 151 million cases, which usually require mechanical ventilation management with the intention of managing the upper airways for ventilation adequate oxygenation of people with COVID-19 and that reduces the risk of contagion for medical personnel. Objective: To describe the anesthetic approach for the induction and maintenance of a tracheoplasty derived from tracheal stenosis secondary to COVID-19. Material and methods: The description of a case and the guidelines that have been given for the management of tracheal stenosis are addressed. Conclusions: Timely anesthetic management and installation of a laryngeal splint is appropriate for the management of tracheal stenosis secondary to the process of prolonged mechanical intubation due to COVID-19.
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OBJECTIVES@#To study the role of bronchoscopy in slide tracheoplasty.@*METHODS@#A retrospective analysis was conducted on the diagnosis and treatment of four children with tracheal stenosis admitted to Hunan Provincial People's Hospital from 2017 to 2020. The role of bronchoscopy was summarized in the preoperative evaluation, intraoperative positioning and measurement, and postoperative wound evaluation and treatment during slide tracheoplasty.@*RESULTS@#Bronchoscopy evaluation before slide tracheoplasty showed that 3 of the 4 children had complete trachea rings, 2 had pulmonary artery sling, and 2 had multiple stenosis. Slide tracheoplasty was performed in the hospital on 3 children, and the midpoint of the stenosis segment was judged under bronchoscopy, and the length of the stenosis segment was measured, which assisted in the resection of the stenosis segment of the trachea. The pathogens were identified by lavage after the surgery. One child who developed scar traction 9 months after slide tracheoplasty in another hospital was improved by interventional treatment under bronchoscopy. Mucosal changes were found under bronchoscopy in 2 children 4 days after surgery, and the treatment plan was adjusted. One month after surgery, 2 children had granulation hyperplasia, which was improved by cryotherapy under bronchoscopy. One child abandoned treatment due to anastomotic necrosis and died. Three survivors were followed up for over 6 months with good prognosis, but all had tracheobronchial malacia.@*CONCLUSIONS@#Bronchoscopy can be used for the management of slide tracheoplasty in children with tracheal stenosis, which is helpful to postoperative rehabilitation and follow-up.
Subject(s)
Child , Humans , Bronchoscopy , Constriction, Pathologic , Retrospective Studies , Trachea/surgery , Tracheal Stenosis/surgery , Treatment OutcomeABSTRACT
Objective:To study the changes of stenotic segment trachea diameter, trachea length and carina angle before and after slide tracheoplasty.Methods:From January 2010 to January 2018, 77 children with congenital tracheal stenosis(female=36) with complete clinical data accepted slide tracheoplasty in Shanghai Children's Medical Center were selected as the observation group. The diameter of stenosis segment, the length of stenosis segment, the full length of trachea and carina angle were measured by CT image, and the ratio of stenosis segment length to full trachea length was calculated. A group of children with normal trachea morphology and the same sample number, and they had no significant difference in age, height and weight were selected as the control group.Results:The median operative age of 77 children in the observation group was 1.3(1.1, 1.9)years old, the height was 76.0(72.0, 83.0)cm, and the weight was 9.0(7.9, 10.8)kg. The age, height and weight of 77 children in the control group were 1.5(1.0, 2.0) years old and 78.0(71.0, 85.0) cm, 9.2(7.9, 11.0) kg respectively. After slide tracheoplasty, the diameter of trachea in the stenotic segment of children increased from 2.7 mm to 4.4 mm, which was increased by 63.0%( P<0.001), but still smaller than that of children in the control group(6.1 mm). The average length of trachea was shortened by 0.7 cm( P<0.001), and there was no significant difference between the total length of trachea(5.4 cm) and the total length of trachea(5.5 cm). The postoperative carina angle decreased by 27.9°( P<0.001), there was no significant difference in postoperative carina angle between the observation group(93.0°) and the control group(90.7°). Conclusion:The diameter of reconstructed trachea in children with CTS is significantly increased, the length and carina angle of trachea become smaller after slide tracheoplasty. The morphology of trachea is more similar to children in the control group.
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A 13-year-old boy underwent tracheostomy due to post-cardiac arrest encephalopathy in our hospital. During the second postoperative month, massive bleeding from the tracheostomy tube lumen was observed; tracheoinnominate artery fistula was diagnosed. Two weeks postoperatively, the trachea collapsed; tracheoplasty with VA-ECMO was performed. The patient was placed in respiratory distress and the tracheostomy cannula was removed. The damaged part of the trachea was trimmed to form a fusiform structure, while the horizontal mattress suture technique was used for tracheoplasty. An endotracheal tube was then placed just above the tracheal bifurcation and the tracheoplasty site was rested. On postoperative day 15, the tube was changed to a tracheostomy one; 3 months postoperatively, no tracheostomy-related complications or rebleeding were observed. Therefore, VA-ECMO assisted tracheal repair is considered a useful treatment option for patients with tracheal disruption, where suturing a prosthesis to the tracheostomy stoma site is difficult.
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RESUMEN La traqueobroncomalacia es una enfermedad de la vía aérea central caracterizada por una debilidad de la pared, con disminución dinámica de la luz de la tráquea y grandes bronquios principalmente durante la espiración. Genera síntomas crónicos que pueden evolucionar hasta la falla respiratoria grave, frecuentemente diagnosticados de forma errónea como asma o enfermedad pulmonar obstructiva crónica (EPOC). Presentamos el caso de una paciente femenina de 70 años, con antecedente de artritis reumatoide y múltiples internaciones por cuadros respiratorios infecciosos en los 3 años previos.
ABSTRACT Tracheobroncomalacia is a disease of the central airway due to weakness of the wall with dynamic narrowing of the lumen of the trachea and mainstem bronchi during exhalation. It produces chronic symptoms that can progress to severe respiratory failure, often misdiagnosed as asthma or chronic obstructive pulmonary disease (COPD). We report the case of a 70-year-old female patient with a history of rheumatoid arthritis and multiple hospitalizations for recurrent respiratory infections over the past 3 years.
Subject(s)
Humans , Female , Aged , Tracheobronchomalacia , Tracheomalacia , Respiratory Insufficiency , Asthma , Signs and Symptoms , Trachea , Bronchi , Exhalation , Tracheobronchomalacia/complications , FrailtyABSTRACT
Objective:To investigate the common types, surgical treatment and effects of tracheal stenosis in children.Methods:A total of 23 children with tracheal stenosis in our hospital from December 2017 to August 2020 were retrospectively reviewed, including 14 males and 9 females. The mean age at operation was(8.9±5.8)months(range: 2-3 months) and the mean weight was(6.4±2.3)kg(range: 4.2-10.5 kg). The common types of tracheal stenosis were complete tracheal ring in 9 children, tracheomalacia in 10 and subglottic membranous annular hyperplasia in 4. The type of congenital heart diseases included 10 patients of pulmonary artery sling, 1 of tetralogy of Fallot, 5 of ventricular septal defect, 1 of pulmonary atresia, and 1 of right aortic arch with aberrant left subclavian artery. Slide tracheoplasty was performed in 9 patients, external splint in 8, endotracheal stent in 2 and tracheal dilation in 4. All children were followed up after 1, 3, 6, and 12 months of operation with CT and bronchoscopy.Results:There was 1 death in all 23 patients and the mortality was 4.3%, which died of granulation tissue hyperplasia after slide tracheoplasty. Reoperation was performed in 1 patient with endotracheal stent. All patients were followed for 1 to 24 months. Clinical symptoms of tracheal stenosis disappeared and the results of CT and bronchoscopy were satisfied.Conclusion:Slide tracheoplasty is the effective surgical method for complete trachea ring. 3D printing bioresorbable external splint is a promising method for the treatment of tracheomalacia.
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A 17-days-old-girl with pulmonary artery (PA) sling, patent ductus arteriosus (PDA), and persistent left superior vena cava was admitted to our hospital. Despite good respiratory status just after birth, the respiratory status gradually worsened, and tracheal intubation was performed on 13th day after birth. Emergency division of the PDA was conducted on day 16. Although preoperative computed-tomography did not demonstrate tracheal stenosis, bronchoscopy after tracheal intubation revealed progression of tracheal stenosis with difficulty for stable anesthetic management. Therefore, operation was postponed to re-evaluate tracheal stenosis. Bronchoscopy and computed-tomography revealed the worsening of tracheal stenosis. Eventually, we performed total correction of the PA sling and tracheal stenosis on day 17. Cardiopulmonary bypass was established after median sternotomy. After transection of the PDA, the left PA originating from the right PA was also transected, and transplanted to the main PA. Then, sliding tracheoplasty was performed following the division of the tracheal stenotic region. Her respiratory condition improved after operation, and postoperative computed-tomography showed successful correction of tracheal stenosis. Although few such cases were reported for neonatal PA sling requiring concomitant tracheoplasty, this case suggests that total correction of PA sling and tracheal stenosis is feasible and useful surgical procedure for such cases.
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Objective To analyze the prognosis of patients with pulmonary artery sling (PAS) combined with tracheal stenosis(TS) without tracheal intervention,and to discuss the method for improving the effect of treatment.Methods The clinical data of 17 children with PAS/TS (moderate or severe) who received treatment at Beijing Bayi Children's Hospital Affiliated to General Hospital of Bejing Military Command from October 2011 to July 2015 were retrospectively analyzed,and the relationship between the effect and prognosis of re-implantation of the left pulmonary artery (LPA) without tracheal intervention was analyzed.Results Seventeen patients received re-implantation of the left pulmonary artery without tracheal intervention.Extubation was successfully performed in 12 of the 17 patients and they healed.The remaining 5 patients received tracheal intervention after the first operation but they all died.Of those 5 patients,3 received tracheal stent implantation (1 died from necrotizing enterocolitis,2 died from infection and multiple organ failure),and 2 received traheoplasty (both of them died from infection and tracheal fistula).Respiratory symptoms were reduced or resolved in all survivors.Diameter/length (％) in survivors without tracheal intervention was significantly higher than those who received tracheal intervention [(10.14 ± 1.58) ％ vs.(5.72 ± 1.17) ％,t =3.600,P ＜ 0.001].Patients with PAS undergoing LPA re-implantation achieved a good outcome if the diameter/length(％) of the trachea was up to (10.14 ± 1.58) ％.Patients with PAS undergoing LPA re-implantation achieved a bad outcome if the diameter/length(％) of the trachea was below to (5.72 ± 1.17) ％.Conclusions Most of patients with PAS/TS undergoing LPA re-implantation without tracheal intervention have a good outcome.It is feasible for them to avoid tracheal intervention.Diameter/length (％) may be a reliable indicator for determining tracheal intervention in surgical management of PAS.
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Introducción: El objetivo del tratamiento del carcinoma diferenciado de tiroides con invasión traqueal es resecar satisfactoriamente la enfermedad conservando las funciones. Caso clínico: Mujer de 27 años, con masa tiroidea con compromiso traqueal evidenciado por tomografía computarizada. Se efectuó tiroidectomía total, linfadenectomía central y selectiva II-V bilateral, resección segmentaria y anastomosis traqueal. En el postoperatorio presentó dehiscencia de la anastomosis, requiriendo traqueostomía. Posteriormente, se efectuó traqueoplastia con evolución favorable. Discusión: La resección traqueal segmentaria es de elección en casos de compromiso local sin enfermedad a distancia. La traqueoplastia permite obtener un resultado funcional satisfactorio en estos casos en centros de alto volumen.
Introduction: The aim of surgery in well-differentiated thyroid cancer with tracheal invasion is to remove all the tumour while preserving functional structures. Clinical case: A 27 year old female presented with a thyroid mass with tracheal invasion on the computed tomography. She underwent total thyroidectomy, bilateral central compartment and selective II-V neck dissection, and tracheal resection with end-to-end anastomosis. She subsequently had anastomotic dehiscence, which required a tracheostomy. Tracheoplasty was later performed with good functional results. Discussion: Segmentary tracheal resection is the procedure of choice in differentiated thyroid cancer with local invasion and with no distant disease. Tracheoplasty, performed in highvolume centres, leads to a satisfying functional outcome.
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The combined effects of inhaled irritant gases and heat in burn patients can result in the development of laryngotracheal strictures. Several factors could adversely affect the development of tracheal stenosis and cause the growth of granulation tissue. Yet the current treatment options for this condition are limited because of the paucity of case reports. We report here on a case of a patient who experienced recurrent upper tracheal stenosis after an inhalation injury. She displayed repetitive symptoms of stenosis even after several laryngomicrosurgeries and resection with end-to-end anastomosis. Finally, 5 yr after the burn injury, slide tracheoplasty was successfully performed and the postoperative check-up findings and the increased airway volume seen on imaging were all satisfactory.
Subject(s)
Humans , Burns , Burns, Inhalation , Constriction, Pathologic , Gases , Granulation Tissue , Hot Temperature , Inhalation , Tracheal StenosisABSTRACT
A causa benigna mais comum de estenose das vias aéreas superiores, em todas as faixas etárias, é a lesão traqueal pós-intubação, que ocorre em 1% a 4% dos pacientes submetidos à ventilação mecânica por longo período. Não tratada, a estenose das vias aéreas cursa com significativa morbidade pulmonar e pode conduzir ao óbito devido ao comprometimento do aparelho respiratório. Dentre as lesões conseqüentes à intubação endotraqueal, é incomum a ocorrência de manifestações clínicas de estenose traqueal. Relata-se o caso de um paciente masculino de 56 anos, que desenvolveu estenose traqueal após ser submetido à intubação endotraqueal por 10 dias, descrevendo seus aspectos patogênicos, clínicos, diagnósticos e terapêutica (AU)
The most common benign cause of upper airway stenosis in all age groups is postintubation tracheal injury, which occurs in 1% to 4% of patients submitted to long-term ventilation. If untreated, airway stenosis causes significant pulmonary morbidity and can progress to life-threatening airway compromise. Among postintubation tracheal lesions, the occurrence of clinical symptoms of tracheal stenosis is uncommon. Here we present the case of a 56-year-old male who developed tracheal stenosis after being submitted to endotracheal intubation for 10 days, describing the physiopathology and clinical aspects of the case as well as its treatment (AU)
Subject(s)
Humans , Male , Middle Aged , Tracheal Stenosis/diagnosis , Intubation, Intratracheal/adverse effects , Trachea/injuries , Tracheal Stenosis/surgeryABSTRACT
La broncoplastia endoscópica es un procedimiento útil en el tratamiento de estenosis tráqueales o bronquiales, por lo general, antes de la colocación de un stent de silicona para preparar el área anatómica de inserción, o como terapéutica provisional para la resolución de estenosis de tráquea, o subglotis en pacientes estables; mientras se programa el tratamiento endoscópico, médico o quirúrgico definitivo. Se presenta el caso de una paciente con estenosis subglótica idiopática a quien se le realizó tratamiento broncoplastia endoscópica con balón obteniéndose resultados favorables hasta la fecha. El objetivo de este artículo es dar a conocer esta útil alternativa terapéutica en Bucaramanga.
Endoscopic bronchoplasty is a useful procedure in the treatment of tracheobronchial stenosis, generally, before the positioning of stent of silicone to prepare the anatomical area of insertion, or like therapeutic provisional for the resolution of estenosis of trachea, or subglottis in stable patients; while the endoscópico treatment is programmed, medical or surgical definitive. We presented the case of a patient with idiophatic subglottal estenosis who we made endoscopic treatment with broncoplastia with ball with favorable results.
Subject(s)
Constriction, Pathologic , Glottis/abnormalities , Respiratory InsufficiencyABSTRACT
Tracheoinnominate artery fistula (TIF) is a very rare complication that can happen after long standing tracheostomy or insertion of an endotracheal tube and its mortality is very high. This condition requires early diagnosis and urgent management because of the life threatening results from tracheal obstruction or hypovolemic shock that is caused by massive bleeding. We report here on a case of successful tracheoplasty with using the costal cartilage, including the perichondrium, in a patient with laryngeal stricture, and this was done to preserve the trachea for the following operation to relieve the laryngeal stricture.
Subject(s)
Humans , Arteries , Cartilage , Constriction, Pathologic , Early Diagnosis , Fistula , Hemorrhage , Mortality , Shock , Trachea , TracheostomyABSTRACT
Objective: Slide tracheoplasty seems to be the most efficient surgical procedure for correcting long-segment funnel-shaped congenital tracheal stenosis. However, in cases of extremely long-segment or those involve carina, slide tracheoplasty when operated alone has certain degree of limitations which often need additional operative procedure. The authors report a technique of slide tracheoplasty in combination with pericardial patch augmentation in a child with congenital tracheal stenosis involving the carina. Methods: A 3-month-old girl, previously diagnosed with Tetralogy of Fallot and congenital tracheal stenosis, presented with severe cyanosis and serious major airway obstruction after a few days of upper respiratory tract infection (URI). Because of the failure to maintain her ventilation with a high positive pressure ventilator, an emergency slide tracheoplasty with a modified right Blalock’s Taussig shunt was performed under a cardiopulmonary bypass. The intraoperative finding revealed a complete tracheal ring stenosis involving the lower half of the trachea and carina. It was transected at the middle and a vertical incision was made at the posterior wall of the upper trachea and anterior wall of the lower and extended into orifices of the main bronchus. The upper and lower tracheal flaps were slid together and sutured with interrupted Proline 5-0. Consequently, she still had significant obstruction of the main bronchi postoperatively and needed a re-operation two days later. Under cardiopulmonary bypass support, the lower anastomotic sutures were removed and an additional bronchial incision was made into the main bronchus. The anterior upper tracheal flap was separated into two, and each equal flap was pulled down and sutured to the main bronchus. Then an autologous pericardial patch was used to cover all the airway defects. Intraoperative fiberoptic bronchoscopy demonstrated adequate tracheo-bronchial lumen. Results: The child had postoperative hyperactive airway reaction and needed prolonged ventilator support and tracheostomy for tracheal toileting. Repeated postoperative bronchoscopy found moderated granulation tissue which was easily removed by catheter suction. Unfortunately, the patient expired six months after the surgery due to uncontrolled sepsis. However, a bronchoscopic finding before the patient’s death revealed adequate major airway patency. Conclusion: Combined slide tracheoplasty with pericardial patch augmentation made reconstruction of the complex congenital tracheal stenosis involving carina or tracheal bronchus possible and minimized the result of unflavoric excessive granulation tissue forming caused by pericardial tracheoplasty alone.
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Congenital tracheal stenosis can be a life-threatening disease, especially in cases involving the long-segment of the trachea. When patients are symptomatic immediately after birth or develop an accompanying complex cardiac anomaly, surgical repair can be a considerable challenge. We experienced a tracheoplasty in one early infant weighing 2.6 kg and one neonate who had ventilator dependency from long-segment congenital tracheal stenosis and congenital cardiac anomaly. One early infant, who had diffuse stenosis of distal trachea after ventricular septal defect closure, underwent resection and extended end to end anastomosis. One neonate who had diffuse stenosis of proximal trachea with tetralogy of Fallot (TOF), underwent slide tracheoplasty with total correction for TOF. Postoperative chest computed tomography showed widely patent trachea. Both infants are now well without symptoms.
Subject(s)
Humans , Infant , Infant, Newborn , Constriction, Pathologic , Heart Septal Defects, Ventricular , Parturition , Tetralogy of Fallot , Thorax , Trachea , Tracheal Stenosis , Ventilators, MechanicalABSTRACT
A lower laryngeal and upper tracheal stenosis that is of idiopathic origin is occasionally seen. It is called an idiopathic tracheal stenosis. These circumferential fibrous stenosis is rare and they are most often located in the subglottic larynx and extend to varying distances predominantly in young women. Because of the unknown nature of the disease process and uncertainty about its future progression, patients were approached conservatively. Recently, surgical resection and reconstruction have been increasingly performed, as favorable results were obtained. Three female patients with dyspnea were admitted. For two patients, they were diagnosed this conditions as bronchial asthma by mistake. All patients were performed computed tomography and bronchoscopy. For two patients with subglottic stenosis, subglottic resection was performed by cervical collar incision, and for the other one patient with distal tracheal stenosis, tracheal resection was performed by right posterolateral thoracotomy. A diagnosis of idipathic tracheal stenosis was confirmed by postoperatively pathologic finding. For one case, because of anastomosis site infection and restenosis, a whole tracheal exposure was performed by cervical collar incision and median sternotomy. And reoperation was performed successfully.
Subject(s)
Female , Humans , Asthma , Bronchoscopy , Constriction, Pathologic , Diagnosis , Dyspnea , Larynx , Reoperation , Sternotomy , Thoracotomy , Tracheal Stenosis , UncertaintyABSTRACT
BACKGROUND: Common treatment modalities for tracheal stenosis include conservative methods such as repeated balloon dilatation, removal of obstructive material through bronchoscopy and T-tube insertion as well as operative treatment methods. Recent advances in surgical approaches through tracheal resection and end-to-end anastomosis have been reported to give better functional and anatomical results. MATERIAL AND METHOD: Between March 1990 and July 2002, 41 patients who received tracheal resection and end-to-end anastomosis at Asan Medical Center, University of Ulsan were studied retrospectively. RESULT: The causes for tracheal resection and end-to-end anastomosis included 26 cases of postintubation stenosis, 10 cases of primary tracheal tumors (3 benign, 7 malignant), 1 case of endobronchial tuberculosis, 2 cases of traumatic rupture, and 2 cases of tracheal invasion of a thyroid cancer. Of the 41 patients who received tracheal resection and reconstruction, 29 received tracheal resection and end-to-end anastomosis, and 12 received laryngotracheal anastomosis with cricoid or thyroid cartilage resection. Four of these patients received supralaryngeal release. The average length of the resected trachea was 3.6+/-1.0 cm. Of the 41 patients who received tracheal resection and end-to-end anastomosis, 30 (73.2%) experienced no postoperative complications, and 8 (19.5%) experienced granulation tissue growth and/or minor infections which improved after conservative management. Good or satisfactory results were therefore achieved in 92.7%. Complications included repeated granulation tissue growth in 7, wound infection in 2, anastomotic site dehiscence in 2, restenosis resulting in dyspnea on exertion in 1, and repeated postoperative aspiration requiring retracheostomy in 1. There was no early postoperative mortality. There were 3 cases of hospital death. CONCLUSION: In cases of proper length of tracheal lesion, excellent results were obtained after tracheal resection and end-to-end anastomosis. But, granulation tissue growth is so serious complication, it is necessary for continuous study and efforts to prevent it.
Subject(s)
Humans , Academic Medical Centers , Anastomosis, Surgical , Bronchoscopy , Constriction, Pathologic , Dilatation , Dyspnea , Granulation Tissue , Mortality , Postoperative Complications , Retrospective Studies , Rupture , Thyroid Cartilage , Thyroid Neoplasms , Trachea , Tracheal Stenosis , Tuberculosis , Wound InfectionABSTRACT
A 60-year-old female was admitted to our hospital complaining of dyspnea.In the past history,she had received tracheal diversion due to recurrent aspiration after brain surgery and tracheostomy.Emergency three dimensional spiral tracheal computed tomograhpy revealed distal tracheal stenosis.The operation was performed by anterior tracheoplasty using glutaraldehyde-soaked autologous pericardium through median sternotomy.Herein we report a case of anterior tracheoplasty using glutaraldehyde-soaked autologous pericardium.
Subject(s)
Female , Humans , Middle Aged , Brain , Glutaral , Pericardium , Tracheal StenosisABSTRACT
Congenital long-segment tracheal stenosis with complex cardiac anomaly has generally been regarded as a fatal disease. This report described the successful concomitant repair of unexpected congenital tracheal stenosis and complex cardiac anomaly with the use of cardiopulmonary bypass. The patient was a 3-month-old girl with coarctation of aorta, VSD, and PDA. The presence of tracheal stenosis was not discovered until when difficulty with endotracheal intubation was encountered at operating room. Thus, we decided concomitant repair of both lesions and performed anterior pericardial tracheoplasty combined with one stage repair of coarctation of aorta, VSD, and PDA under the cardiopulmonary bypass. The patient is doing well without any signs of complication at present, 2 years and 1 month after the operation.
Subject(s)
Female , Humans , Infant , Aortic Coarctation , Cardiopulmonary Bypass , Heart Defects, Congenital , Intubation, Intratracheal , Operating Rooms , Tracheal StenosisABSTRACT
Long, severe, and fixed congenital tracheal stenosis is a life-threatening anornaly and not relieved by endotracheal or tracheostomy intubation. The rarity of congenital tracheal stenosis has not allowed sufficient experience for the development of standard treatment methods, therefore, congenital tracheal stenosis still carries significant morbidity, with a mortality rate as high as 70%. We have followed up two patients managed by different methods, but O(2)-isoflurane-Fentanyl-vecuronium was used for induction and maintenace. We experienced one case of tracheoplasty with pericardial patch for extensive tracheal stenosis under extracorporeal circulation, and one case of slide tracheoplasty for funnel-shaped tracheal stenosis. The first case was noticed incidentally during anesthetic induction and the vocal cord was visible but 2.5 mm sized tube could not be advanced,so we used the guide wire which is used for central line, then we could intubate with some resistance. Tracheostomy was not allowed due to diffuse tracheal stenosis reaching from cricoid cartilage to carina. During the extra corporial circulation, the guide wire was inserted from operation field, and 3.5 mm sized tube was introduced via guide wire by anesthesiologist. After operation the grannulation tissue that obstructing airway, was noticed by bronchoscopy, and was removed, then he was weaned from ventilator successfully. The second case was discovered due to diffcult weaning from ventilator after open heart surgery. the bronchogrm showed right tracheal bronchus and diffuse tracheal stenosis from T2 to carina. He was ventilated initially with 4.0 mm sized endotracheal tube, and ventilated intermittently with other 2.5 mm sized endotracheal tube from operation field during tracheal anastomosis. After operation, he died with increased airway pressure and airway bleeding.