Abstract
Tracheoesophageal fistula (TEF) is a rare congenital developmental anomaly, affecting 1 in 2500–3000 live births. The H-type TEF, consisting of a fistula between the trachea and a patent esophagus, is one of the rare anatomic subtypes, accounting for 4% of all TEFs. The presentation and perioperative management of neonates with H-type TEFs and all other TEFs are very similar to each other. Patients present with congenital heart disease and other defects and are prone to recurrent aspirations. A barium esophagogram or computed tomography of the chest is a common means to the diagnosis, and surgical repair is carried out through either a cervical approach or a right thoracotomy. During operation, anesthetic management is focused on preventing positive pressure ventilation through the fistula in an attempt to minimize gastric distension. For patients with H-type TEFs, because of the patent esophagus, symptoms are often less severe and nonspecific, resulting in subtle yet important differences in their diagnostic workup and management. This review will cover the finer details in the diagnosis and perioperative anesthetic management of TEF patients and clarify how H-type TEF distinguishes itself from the other anatomic subtypes.
Highlights
Tracheoesophageal fistula (TEF) is a congenital developmental anomaly that affects approximately 1 in 2500–3000 live births [1]
TEF is classified into five subtypes based on the location of fistula and the presence or absence of esophageal atresia
We will focus our review on isolated TEF without esophageal atresia
Summary
Tracheoesophageal fistula (TEF) is a congenital developmental anomaly that affects approximately 1 in 2500–3000 live births [1]. TEF is classified into five subtypes based on the location of fistula and the presence or absence of esophageal atresia. We will focus our review on isolated TEF without esophageal atresia (type H). Lamb reported the first case of H-type TEF in 1873. E first surgical repair was reported by Imperatori in 1939. E exact pathogenic mechanism of TEF is unclear. It is thought to be due to incomplete separation of the tracheal bud from the primitive foregut during the 4th or 5th week of embryogenesis. E incidence of associated congenital anomalies is lower in H-type TEF compared to patients with other types of TEF It is thought to be due to incomplete separation of the tracheal bud from the primitive foregut during the 4th or 5th week of embryogenesis. e incidence of associated congenital anomalies is lower in H-type TEF compared to patients with other types of TEF
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