Die kardio-respiratorische Belastung beim tracheo-�sophagealen Shunt nach Staffieri

Abstract

The tracheo-esophageal shunt has not to be created too wide because of the danger of aspiration; but narrow shunts require high intrathoracical pressure for phonation. In seven patients a pulmonary function test was done and then the mean air flow and the esophageal pressure during phonation were measured. In four of these patients we obtained sufficient data: one patient showed a shunt resistance of 35 cm H2O/l/s which is comparable to the phonatory resistance of a normal glottis. In the three other patients resistances were found being 10–80 times higher than the normal glottal resistance. In those two patients having the lowest and the highest shunt resistance, respectively, the change of blood pressure in the pulmonary artery during phonation was recorded by cardiac catheterisation. In the patient with low resistance the mean arterial pressure increased twofold, whereas the other one showed a sixfold increase. From these observations it is concluded that phonation with a Staffieri-shunt often does not only mean a considerable respiratory load, but also a cardiovascular stress in the sense of the Valsalva-maneuver. Therefore, chronic lung and heart diseases should be regarded as contraindications against a Staffieri-shunt.