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Severe lower tracheal stenosis in infancy
G Krandick1, K Mantel, C Schiller
1Department of Pediatric Surgery, Dr. von Haunersches Kinderspital, University of Munich, Germany.
Insights
Severe tracheal stenosis in infants often involves vascular anomalies. Surgical correction is preferred, but dilatation and stenting are vital for managing these complex airway conditions.
Area of Science:
- Pediatric Surgery
- Pulmonology
- Medical Imaging
Background:
- Severe distal tracheal stenosis (TS) presents significant challenges in infant care.
- Congenital TS can be associated with complex vascular anomalies, impacting treatment strategies.
Purpose of the Study:
- To review the diagnosis, management, and outcomes of infants with severe distal tracheal stenosis.
- To evaluate the effectiveness of different treatment modalities for congenital TS and related conditions.
Main Methods:
- Retrospective review of 16 infants diagnosed with severe distal tracheal stenosis between 1978 and 1988.
- Diagnosis confirmed via endoscopy and radiographic methods, including MRI in select cases.
- Analysis of treatment approaches including tracheal resection, dilatation, stenting, and surgical correction of associated vascular anomalies.
Main Results:
- 56% of patients had associated vascular anomalies.
- Tracheal resection, dilatation, and observation were employed for congenital TS, with varying survival rates.
- Pulmonary artery sling and anomalous aorta compression required specific surgical or interventional approaches.
- Overall mortality was 50% across all treatment groups.
Conclusions:
- Endoscopic examination and thorough anomaly evaluation are crucial for symptomatic infants.
- Surgical correction is the primary treatment for tracheal stenosis when indicated.
- Dilatation and stenting serve as essential tools in managing infant tracheal stenosis.
Abstract:
16 infants with severe distal tracheal stenosis (TS) seen from 1978-1988 are reviewed. Diagnosis was established by endoscopy and confirmed by radiographic methods, including magnetic resonance imaging (MRI) in three cases. Types of TS ranged from segmental stenosis to complex lesions involving the carina and bronchi. Associated vascular anomalies were found in nine patients (56%). All patients needed long-term intubation or a tracheostomy (seven cases) for stenting of the airway. Patients with congenital TS (CTS) were treated by tracheal resection (two survivors), dilatation (one survivor, two non-survivors), or observation (two non-survivors). Patients with pulmonary artery sling (PAS) were treated by division of the vascular sling (three survivors, one non-survivor), or combined vascular and tracheal surgery (one non-survivor). One patient with dilated pulmonary arteries compressing both main bronchi died in spite of oxygen therapy. Two cases of compression by an anomalous aorta were managed with dilatation (one survivor, one non-survivor). One patient with a severe stricture after a tracheal resection was successfully treated by dilatation. The overall mortality was 50%. We conclude that 1. endoscopic examination of the tracheobronchial tree and thorough evaluation of associated anomalies is mandatory in symptomatic patients; 2. if indicated surgical correction is the treatment of choice for tracheal stenosis; 3. dilatation and stenting of the stenosis are invaluable tools in the management of these infants.