RESUMO
Congenital tracheal stenosis is very rare, but it leads to life threatening obstruction in infancy and childhood. Recently, we experienced two cases of congenital tracheal stenosis, involving half of the distal trachea. We adopted slide tracheoplasty procedure proposed by Peter Goldstraw. Tracheoplasty was performed by dividing the stenosis at midpoint, incising the proximal and distal narrow segments vertically on opposite anterior and posterior surfaces, and sliding these together. On case 1, the patient is now doing well. On case 2, the patient succumbed due to anastomotic disruption at postoperative day 4.
Assuntos
Humanos , Constrição Patológica , Traqueia , Estenose TraquealRESUMO
Understanding of the surgical anatomy of patients with double outlet right ventricle (DORV) is important in the planning of biventricular repair. From May 1995 to September 1996, 7 patients underwent biventricular repair for DORV with remote ventricular septal defect. There were 5 males and 2 females. Age at operation varied from 2 to 9 years(mean 3.4+/-2.7years). Preoperative diagnostic assessment was made by two-dimensional echocardiography and cardiac catheterization. Ventricular septal defect was perimembranous inlet type in all patients. Associated cardiac anomalies were pulmonary atresia in two, pulmonary stenosis in five and tricuspid chordae attachment to conal septum in five. The operations were performed intraventricular repair and pulmonary enlargement in two, REV operation in two, and Rastelli operation in three. There was no early postoperative deaths and complications. The follow-up period was from 1 month to 18months, averaging 10+/-6.1 months. In the past,we considered the Fontan operation indicative as primary choice when DORV was associated with abnormal tricuspid chordal attachment to the conal septum,but now we believe that biventricular repair is feasible for those cases by making conal flap or reattachment method. Biventricular repair has theoretic advantages because it estabilishes normal anatomy and physiology,and it was concluded that the precise preoperative evaluation using both echocardiography and cardiac catheterization was essential to the successful surgery.
