Treatments and outcomes of subglottic stenosis in children after surgical repairing congenital heart disease

Abstract

Objective To explore the treatments and outcomes of children complicated with subglottic stenosis after surgical repairing congenital heart disease(CHD). Methods A total of 34 cases complicated with subglottic stenosis after CHD surgery from July 1, 2010 to June 30, 2013 were retrospectively analyzed. There were 19 boys and 15 girls with an average age of 7.8±1.6 months and an average weight of 5.5±3.0 kilogram. According to the Cotton's subglottic stenosis grading system, the degrees were Ⅰ(n=5), Ⅱ(n=12), Ⅲ(n=17) and Ⅳ(n=0). They were divided into two groups of A(intubation, n=8) and B(non-intubation, n=26) according to treatment plan. Group A had endotracheal intubation implanted for over 24 h after endotracheal tube dilatation or subglottic stenosis surgery. Systemic infusion of dexamethasone was used for 1 week. Group B had an immediate extubation after dilatation. Dexamethasone infusion and budesonide atomization were administered for 1 week. Chi-square or Fisher's exact test was used to compare the profiles of readmission, re-stenosis rate and mortality for two groups. Statistical analysis was performed with 16.0 SPSS software. P<0.05 was considered statistically significant. Results All patients completed treatment. The median follow-up period was 15 months. The readmission rate(11.5% vs 75.0%), re-stenosis rate(11.5% vs 87.5%)and mortality(3.8% vs 37.5%) of group B were significantly lower than those of group A. And the differences were statistically significant(P<0.05). Conclusions Subglottic stenosis is a rare postoperative complication of congenital heart disease. Early diagnosis and proper interventions yield a good prognosis. Tracheal extubation immediately after dilatation with endotracheal tube to treat subglottic stenosis is both simple and suitable for wider popularization at primary hospitals. Key words: Subglottic stenosis; Heart diseases, congenital; Follow-up studies