Tratamiento quirúrgico de la estenosis traqueal en pediatría / Surgical treatment of tracheal stenosis in pediatrics

Veinte pacientes con estenosis de tráquea fueron intervenidos quirúrgicamente entre julio de 2005y mayo de 2008, diez con estenosis congénita y diez de origen adquirido.La sobrevida global fue de 85 por ciento. Fallecieron tres pacientes, uno con estenosis adquirida y dos conestenosis congénita.De los diecisiete sobrevivientes, quince se encuentran asintomáticos; dos pacientes operados por estenosis congénita requieren controlesperiódicos (ambos con tutores endoluminales [stents] colocados).La estenosis traqueal adquirida presenta menos complicaciones, requiere menos asistencia respiratoria y menor estadía hospitalaria en el posoperatorio. Los pacientes con estenosis traquealcongénita necesitan, generalmente, másde un procedimiento terapéutico y presentan mayor mortalidad.

Tratamento cirúrgico das estenoses traqueais congênitas / Surgical treatment of congenital tracheal stenoses

OBJETIVO: Analisar os desfechos dos pacientes submetidos ao reparo de estenose congênita de traqueia. MÉTODOS: Análise retrospectiva dos pacientes com estenose traqueal congênita tratados no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 2001 e 2007. RESULTADOS: Seis meninos e uma menina (idade ao diagnóstico entre 28 dias e 3 anos) foram incluídos. Cinco pacientes apresentavam malformações intracardíacas e/ou de grandes vasos associadas. A extensão das estenoses foi curta em três pacientes, média em um e longa em três. As técnicas utilizadas foram traqueoplastia com enxerto de pericárdio em três pacientes, ressecção e anastomose em dois, traqueoplastia em bisel em um e correção de anel vascular em um. Um paciente morreu no intraoperatório por hipóxia e instabilidade hemodinâmica e outro no 11º dia pós-operatório por choque séptico. Outras complicações observadas foram pneumonia, arritmia, estenose na anastomose e estenose residual, malácia e formação de granulomas. O tempo médio de seguimento pós-operatório foi de 31 meses; quatro pacientes ficaram livres da doença e um necessitou de tubo T para manter a via aérea pérvia. CONCLUSÕES: A estenose congênita de traqueia é uma doença curável. Entretanto, seu reparo é complexo e está associado a taxas de morbidade e mortalidade significativas.

OBJECTIVE: To analyze the outcomes of patients undergoing repair of congenital tracheal stenosis. METHODS: This was a retrospective review of congenital tracheal stenosis patients treated between 2001 and 2007 at the University of São Paulo School of Medicine Hospital das Clínicas in São Paulo, Brazil. RESULTS: Six boys and one girl (age at diagnosis ranging from 28 days to 3 years) were included. Five of the patients also had cardiac or major vessel malformations. The stenosis length was short in three patients, medium in one and long in three. The techniques used were pericardial patch tracheoplasty in three patients, resection and anastomosis in two, slide tracheoplasty in one and vascular ring correction in one. One patient died during surgery due to hypoxia and hemodynamic instability, and one died from septic shock on postoperative day 11. Other complications included pneumonia, arrhythmia, stenosis at the anastomosis level, residual stenosis, granuloma formation and malacia. The mean follow-up period was 31 months; four patients were cured, and one required the use of a T tube to maintain airway patency. CONCLUSIONS: Congenital tracheal stenosis is a curable disease. However, its repair is complex and is associated with high rates of morbidity and mortality.

Repair of Long-segment Congenital Tracheal Stenosis

Long-segment tracheal stenosis in infants and small children is difficult to manage and can be life-threatening. A retrospective review of 12 patients who underwent surgery for congenital tracheal stenosis between 1996 and 2004 was conducted. The patients' median age was 3.6 months. All patients had diffuse tracheal stenosis involving 40-61% (median, 50%) of the length of the trachea, which was suspected to be associated with complete tracheal ring. Five patients had proximal bronchial stenosis also. Ten patients had associated cardiac anomalies. Three different techniques were performed; pericardial patch tracheoplasty (n=4), tracheal autograft tracheoplasty (n=6), and slide tracheoplasty (n=2). After pericardial tracheoplasty, there were 2 early and 2 late deaths. All patients survived after autograft and slide tracheoplasty except one who died of pneumonia one year after the autograft tracheoplasty. The duration of ventilator support was 6-40 days after autograft and 6-7 days after slide tracheoplasty. The duration of hospital stay was 13-266 days after autograft and 19-21 days after slide tracheoplasty. Repeated bronchoscopic examinations were required after pericardial and autograft tracheoplasty. These data demonstrate that pericardial patch tracheoplasty show poor results, whereas autograft or slide tracheoplasty gives excellent short- and long-term results.

Slide tracheoplasty for severe congenital long segment tracheal stenosis in infants: surgical and anesthetic management.

Congenital long segment tracheal stenosis is the rare occurrence of an intrinsic narrowing of the trachea due to a complete cartilagenous ring. It is difficult to manage and can be life threatening especially when these patients who are usually neonates or infants have the pathological pattern of a long segment and have to come for surgical correction. Despite many technical reports on how to correct this anormaly, currently, the technique of "slide tracheoplasty" is claimed to be the most successful with the good immediate and long-term outcomes. But because of the rare and life threatening disease, so we were encouraged and write this report about the disease and its management. These are the case series reports of 4 infants with a history and diagnosis of severe long segment congenital tracheal stenosis who needed a difinite surgical repair. The authors decided to use the surgical technique of "slide tracheoplasty" with successful outcome. In two of the cases, patients needed cardioplumonary bypass support during the surgical repair. All of these patients did well after the operation except one patient with a history of congenital heart disease (tetralogy of Fallot) who needed an emergency surgical repair and was reoperated upon with pericardial patch. In this reports the authors did not find any benefit from tracheostomy. Also, details of surgical and anesthetic procedure were discussed with the conclusion that the surgical technique of slide tracheoplasty should be the surgical of choice for the management of congenital long segment tracheal stenosis.

Unusual association of pulmonary artery sling with right aortic arch and aberrant left subclavian artery

We present an unusual case of vascular sling, tracheal stenosis by complete cartilaginous ring, and aberrant left subclavian artery with right aortic arch that underwent successful surgical repair for the sling. These abnormalities were suspected from unusual multiple indentations found on esophagogram. Complete preoperative diagnosis was established with chest computerized tomogram combined with angiography.

Estenosis traqueal congénita: reparación con injerto de pericardio, en by pass cardiopulmonar: reporte de caso clínico / Congenital tracheal stenosis: repaired using cardiopulmonar bypass and pericardial graft: case report

Se describe el caso clínico de un recién nacido portador de estenosis traqueal congénita. La lesión estenótica compromete la tráquea ampliamente, en la región intratorácica y ocasiona una insuficiencia respiratoria grave que requiere cirugía reparadora de emergencia. La tráquea es reparada con parche de pericardio, con el apoyo de by pass cardiopulmonar. Posteriormente se instala un stent metálico intraqueal para dar sustentación al injerto de pericardio

Estenosis traqueal congénita asociada a cardiopatía corrección quirúrgica en un tiempo / Congenital tracheal stenosis. Surgical treatment

Se comunica el caso de una niña de 1 año de edad portadora de estenosis congénita de la tráquea asociada a cardiopatía congénita. La reconstrución traqueal fue relizada en el mismo acto quirúrgico de la reparación de los defectos intracardíacos asociados, con utilización de circulación extracorpórea. Para reparar el segmento estenótico se utilizo un parche de perícardio autólogo. El curso postoperatorio fue favorable. El calibre adecuado de la luz traqueal fue confirmado a través del examen tomográfico y endoscópico realizado tres meses luego de la intervención. Después de 9 meses de seguimiento la paciente contínua bien.

Estenose congênita de traquéia: diagnóstico diferencial com anel vascular, relato de caso / Congenital trachecil stenosis: differential diagnosis with vascular ring. report of a case

Um menino de três anos de idade, com sinais de obstruçäo respiratória alta desde o nascimento foi submetido à ressecçäo do segmento traqueal estenótico resultando a cura. Ressalta-se a necessidade de estabelecer o diagnóstico diferenciawl entre os diferentes tipos de obstruçäo respiratória na infância. Sublinha-se a distinçäo entre estenose traqueal segmentar e anomalias do arco aórtico, estabelecida com o auxílio de traqueoscopia, aortografia e traqueografia. Descreve-se o tratamento efetuado