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Tracheoplasty for congenital complete tracheal rings
T M Andrews1, R T Cotton, W W Bailey
1Department of Pediatric Otolaryngology, All Children's Hospital, St Petersburg, Fla.
Insights
Congenital complete tracheal rings cause pediatric tracheal stenosis, often requiring tracheoplasty. This study found a high 47% mortality rate for this complex surgical repair in infants.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Anomalies
Background:
- Congenital complete tracheal rings present a complex challenge in pediatric patients.
- Tracheal stenosis due to these rings typically manifests with respiratory compromise in infancy.
Purpose of the Study:
- To evaluate the clinical presentation, diagnostic methods, surgical repair necessity, associated anomalies, and outcomes for pediatric patients with tracheal stenosis caused by congenital complete tracheal rings.
Main Methods:
- Retrospective study of 18 pediatric patients with long-segment tracheal stenosis due to congenital complete tracheal rings (1985-1991).
- Fifteen patients underwent tracheoplasty with cardiopulmonary bypass via midline sternotomy; three did not require surgery.
- Diagnostic methods included endoscopic examination, plain film roentgenography, and in selected cases, CT or MRI.
Main Results:
- Patients typically present with respiratory compromise within the first year of life.
- Diagnosis often relies on endoscopic findings and imaging.
- The study evaluated symptoms, stenosis length, repair type, intubation duration, complications, and mortality.
Conclusions:
- Tracheoplasty techniques have evolved, incorporating posterior/anterior divisions and pericardial grafting.
- The observed mortality rate for tracheoplasty in this cohort was 47%, which is notably high compared to existing literature.
Objective:
To better appreciate the complex nature of the pediatric patient with tracheal stenosis due to congenital complete tracheal rings, we evaluated clinical presentation, methods of evaluation, necessity for surgical repair, associated anomalies, and outcome.
Design:
Retrospective study.
Patients:
Eighteen patients with long-segment tracheal stenosis due to congenital complete tracheal rings were evaluated at Cincinnati (Ohio) Children's Hospital Medical Center between 1985 and 1991. Three patients did not require surgical intervention. Fifteen patients underwent tracheoplasty with cardiopulmonary bypass through a midline sternotomy.
Results:
The patients with congenital complete tracheal rings usually present with respiratory compromise in the first year of life. In the majority of patients, a diagnosis was made based on the symptoms and findings of an endoscopic examination with the aid of plain film roentgenography. In selected patients, computed tomography or magnetic resonance imaging was used. We evaluated symptoms, length of stenosis, type of repair, duration of intubation, and complications, as well as the mortality associated with this procedure.
Conclusions:
The technique of tracheoplasty has evolved at our institution, including the use of a posterior tracheal division, anterior castellated division, autologous pericardial patch grafting, and cricoid split with intubation for 7 to 21 days. We found the mortality associated with this procedure quite high at 47%, compared with previously published reports with mortality figures between zero and 77%.