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Morphologic Analysis of Congenital Heart Disease With Anomalous Tracheobronchial Arborization

Xiaoqi Song1, Zhaohui Lu1, Limin Zhu1

  • 1Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.

The Annals of Thoracic Surgery
|March 2, 2020
PubMed

Insights

Anomalous tracheobronchial arborization (ATBA) is common in congenital tracheal stenosis, often linked to abnormal embryonic development. Tracheoplasty is the optimal surgical treatment for all ATBA types in these patients.

Area of Science:

  • Thoracic surgery
  • Pediatric surgery
  • Congenital anomalies

Background:

  • Congenital heart disease (CHD) frequently co-occurs with anomalous tracheobronchial arborization (ATBA).
  • Investigating the interplay between CHD and ATBA is crucial for understanding congenital tracheal stenosis.
  • ATBA may stem from abnormal embryonic development, not solely vascular compression.

Purpose of the Study:

  • To characterize the morphologic features of ATBA in patients with congenital tracheal stenosis.
  • To establish a new classification of ATBA for improved surgical treatment considerations.
  • To evaluate the association between ATBA types and congenital heart defects, particularly pulmonary artery sling.

Main Methods:

  • Retrospective review of 147 patients with ATBA.
  • Classification of ATBA into four types (A, B, C, D).
  • Analysis of tracheal stenosis rates, tracheoplasty procedures, carina/pseudocarina angles, and co-occurring CHD, including pulmonary artery sling.

Main Results:

  • ATBA was identified in a significant proportion of patients with congenital tracheal stenosis.
  • Tracheoplasty was performed in 113 out of 128 patients with tracheal stenosis and complete tracheal rings.
  • Type C ATBA showed a higher tracheoplasty rate (100%) compared to Type A (62.1%).
  • Postoperative carina/pseudocarina angle reduction was significant.
  • Pulmonary artery sling was present in 60.9% of repaired cases.

Conclusions:

  • ATBA is a common finding in congenital tracheal stenosis, suggesting a shared embryonic origin.
  • A novel ATBA classification system offers clinical utility for surgical planning.
  • Tracheoplasty remains the preferred surgical intervention for all identified ATBA types.
Abstract

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