Surgical reconstruction of congenital tracheal stenosis in conjunction with congenital heart disease in infants

Abstract

Objective To evaluate the short-medium-term clinical effects of surgical reconstruction of congenital tracheal stenosis(CTS) in conjunction with congenital heart disease(CHD) in infants. Methods The clinical materials of 11 cases of CTS with CHD in our hospital from August 2011 to May 2015 were analyzed retrospectively. There were 7 boys and 4 girls with the mean operation age of(6.2±2.1) months and the mean body weight of(6.3±1.6) kg.Eight of the 11 patients had long-segment tracheal stenosis while 3 had short-segment tracheal stenosis. Of all the patients, 8 were diagnosed with vascular ring including 6 pulmonary artery sling. The diagnosis of airway obstruction was made concomitantly with the diagnosis of other heart defect including ventricular septal defect, atrial septal defect, patent ductus arteriosus, partial atrioventricular septal defect, coarctation of aorta and partial anomalous pulmonary venous connection. All operations were performed through a median sternotomy with cardiopulmonary bypass(CPB) support. Associated cardiovascular anomalies were repaired before the tracheoplasty. Repairs with slide tracheoplasty were performed in the patients with long-segment tracheal stenosis while stenoticsegments resection and end-to-end anastomosis in the patients with short-segment stenosis. Results The median CPB time was 165(range, 133-306) minutes. The medianpost-operative mechanical ventilation time was 11(range, 5-18)days. The median hospitalization time after operation was 24(range, 15-59) days, and median total hospital costs were 119(range, 66-202) thousand yuan. One of the patients died in the hospital because of hypoxic encephalopathy which led to the abandoning treatmentat 23 days after operation. The median follow-up time for the patients was 14.6(range, 3.5-49.0) months. One of the patients underwent another surgical intervention at 2 months after the first operation because of significant granulations caused by respiratory infection. Family members of the patient abandoned treatment because of uncontrolled infection; Three of the children with recurrent respiratory tract infection got better after timely medical treatment and discharged without reoperation; The remaining 6 patients recovered well. Conclusion The short-medium-term clinical effects are good for surgical reconstruction of CTS in conjunction with CHD in infants. Part of the patients encounter recurrent respiratory tract infection which could be controlled ultimately. However, it still needs long-term follow-up and further study to assess their medium-long-term curative effects. Key words: Congenital tracheal stenosis; Congenital heart disease; Surgery; Infant