Stenosis In Neonates Research Articles

Congenital nasal stenosis in neonates.

Sixteen newborn infants with respiratory problems due to bony nasal obstruction were studied. In 14 patients no surgery was needed. In two patients surgery became necessary after a few months. Congenital narrowing of the nasal passage was unknown until recently. The origin of the disorder is discussed.

Percutaneous balloon dilatation of aortic valve stenosis in neonates and infants.

Percutaneous balloon dilatation of severe aortic valve stenosis was attempted in thirteen patients (seven neonates and six infants). In two the valve could not be crossed and both died during subsequent operation. Two patients died during manipulation of the balloon catheter. No significant benefit was obtained in another patient who later died during operation. Balloon dilatation was successful in the remaining eight patients, reducing the aortic valve pressure gradient from a mean of 63 mmHg (95% confidence interval 38 to 88 mmHg) to a mean of 23 mmHg (95% confidence interval 7 to 39 mmHg). Two of these patients subsequently died from heart failure related to other cardiac lesions. The six survivors have done well. At follow up the maximum Doppler velocities in the ascending aorta ranged from 1.9 to 4.0 m/s after 2-23 months, but despite this evidence of an increasing valve gradient there has been lasting clinical improvement.

Central aorta-pulmonary artery shunts in neonates with complex cyanotic congenital heart disease

Methods of palliating critical pulmonary oligemia in neonates with complex cyanotic congenital heart disease continue to evolve. Pulmonary artery distortion and other complications of the use of native vessels to increase pulmonary blood flow has led to the more frequent use of polytetrafluoroethylene shunts either in a central position or as a modified Blalock-Taussig shunt. Central aorta-pulmonary artery shunts have largely fallen into disfavor because of previously reported unacceptably high incidences of complications such as shunt thrombosis, congestive heart failure, and pulmonary artery distortion. This report details our experience palliating 23 neonates with pulmonary atresia or severe pulmonary stenosis by placing central aorta-pulmonary artery shunts utilizing a short segment (less than 1 cm) of polytetrafluoroethylene. Although three of the 23 died postoperatively, none of the 23 patients had evidence of shunt thrombosis. Congestive heart failure, a potential complication of any pulmonary artery shunt, was present in eight of the 20 survivors but did not require shunt takedown and was readily controlled by digoxin. Repeat catheterization was performed in 12 patients; pulmonary angiography showed good growth of both pulmonary arteries and there was no evidence of pulmonary artery hypertension. Although minor pulmonary artery distortion was present in two patients, this distortion was centrally located and easily remedied at the time of total correction. Thus we have found the central aorta-pulmonary artery shunt to be an extremely effective and reliable means of palliating pulmonary artery hypoplasia as a result of pulmonary atresia or severe pulmonary stenosis in neonates.

Primary repair of interrupted aortic arch and severe aortic stenosis in neonates

Two infants, aged 36 days old (Case 1) and 18 days old (Case 2) with interrupted aortic arch types B and A, respectively, and with severe aortic stenosis, were successfully operated on by use of pulsatile cardiopulmonary bypass. The great arteries were normally related in Case 1 and were transposed in Case 2. Repair involved the following procedure: ligation of the patent ductus arteriosus, restoration of aortic continuity with an 8 mm polytetrafluoroethylene graft, placement of an internal patch to tunnel all left ventricular blood from the left ventricle through the ventricular septal defect into the pulmonary artery in Case 1 and patch closure of the ventricular septal defect in Case 2, transection of the main pulmonary artery, anastomosis between the proximal pulmonary artery and the ascending aorta, and interposition of a valved conduit between the right ventricle and the distal pulmonary artery. The operative field could be approached easily through a median sternotomy. Postoperative cardiac catheterization revealed satisfactory anatomical and hemodynamic results in both cases.

Risk factors for neonatal acquired subglottic stenosis.

Endotracheal intubation has proven to be a relatively safe and effective means of securing the airway in neonates. Some concern remains, however, regarding airway management in critically ill infants who require assisted ventilation for extended periods. Among the various risk factors associated with the complication of acquired subglottic stenosis in neonates, the one most frequently cited has been "prolonged" intubation, although opinion varies regarding the definition of this term. Various recommendations exist that attempt to establish the limits of "safe" periods of intubation for infants. Some feel that tracheotomy is indicated when airway support is required beyond those limits. In an attempt to define important risk factors involved in the development of neonatal subglottic stenosis, a retrospective analysis of infants admitted to the Neonatal Intensive Care Unit of Columbus Children's Hospital who required intubation during a 3-year period from 1977 to 1980 was undertaken. Of 343 infants who survived hospitalization, five patients were identified as having acquired subglottic stenosis. The average duration of intubation for these five patients was 56.2 days. The incidence of subglottic stenosis for infants whose duration of intubation ranged from 3 to 50 days was 0.4% (1/245). Infants with birth weights less than 1,500 g appeared more susceptible to the development of intubation-related laryngeal injury. The conclusion of this study is that endotracheal intubation is an appropriate means of long-term airway management in neonates hospitalized in a pediatric intensive care unit, providing other known risk factors are minimized.

Acquired subglottic stenosis in neonates

Clinical Otolaryngology & Allied SciencesVolume 10, Issue 6 p. 299-302 Acquired subglottic stenosis in neonates S. J. Gould, S. J. GouldSearch for more papers by this authorJ. M. Graham, J. M. GrahamSearch for more papers by this author S. J. Gould, S. J. GouldSearch for more papers by this authorJ. M. Graham, J. M. GrahamSearch for more papers by this author First published: December 1985 https://doi.org/10.1111/j.1365-2273.1985.tb00259.xCitations: 17AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume10, Issue6December 1985Pages 299-302 RelatedInformation

Normothermic caval inflow occlusion: Application to operations for congenital heart disease

The technique of normothermic caval inflow occlusion was introduced primarily for relief of pulmonary valve stenosis and continues to be used for this purpose with excellent results. However, the technique may also be applied to a number of other lesions such as aortic valve stenosis in neonates and infants, for placement of outflow patches or valve excision for pulmonary atresia with intact ventricular septum, for atrial septectomy in children with restrictive atrial septum, and for other conditions wherein a period of up to 2 minutes of intracardiac exposure is sufficient. This report examines the early and long-term results in 140 children who underwent normothermic caval inflow occlusion at The Children's Hospital, Boston, Massachusetts, over the past 11 years. Ninety-four children underwent pulmonary valvotomy (early mortality 0%), 21 had aortic valvotomy (19%), 10 with pulmonary atresia and intact ventricular septum underwent various procedures (50%), 11 had atrial septectomy (9%), and there were four miscellaneous procedures (50%). Apart from avoiding many of the potential complications of cardiopulmonary bypass, inflow occlusion has provided as good or better short-term and long-term results as those obtained with cardiopulmonary bypass, particularly in infants and neonates, and also has proved more cost effective.

Transventricular Balloon Catheter Aortic Valvotomy in Neonates

Surgical intervention for critical aortic stenosis in neonates is associated with an appreciable risk. Refinements in the technique of aortic valvotomy have been developed in an attempt to lower the operative mortality. This case report summarizes our experience with transventricular balloon dilation of critical aortic stenosis in 2 neonates. Both patients survived operation with objective evidence of hemodynamic improvement.

Treatment of severe subglottic stenosis without tracheotomy: a preliminary report.

Subglottic stenosis in neonates, infants and children is one of the most challenging problems confronting the pediatric otolaryngologist today. Small patients with congenital or acquired stenosis were enough to require tracheotomy must undergo repeated endoscopic procedures or laryngotracheal reconstruction; weeks, months, or years may be required to attain a lumen large enough to permit decannulation. During 1981, six infants and children with severe subglottic stenosis were managed without tracheotomy. The surgical technique employed involves endoscopic excision of the offending subglottic tissue using the CO2 laser and suspension microlaryngoscopy. Intraoperative intubation is avoided by using an insufflation technique for general anesthesia which permits unobstructed visualization of the larynx, thereby avoiding laryngeal trauma and edema.

Recurrent lobar atelectasis due to acquired bronchial stenosis in neonates

Bronchial obstruction by granulation tissue caused atelectasis in ten infants who required frequent suctioning and mechanical ventilation for more than 20 days. The endotracheal suctioning had been performed with a No. 6 or No. 8 French catheter with multiple end and side holes at the tip. Bronchoscopic examination revealed nodular and polypoid granulation at the level of the carina and bronchus, more often on the right side. In five infants, atelectasis was treated with gentle, less frequent suctioning and vigorous pulmonary toilet. Two of these infants died of severe atelectasis and chronic lung disease. Five infants underwent excision or cauterization of granulation tissue. Histopathologic examination of this tissue disclosed inflammation, fibrosis, and squamous metaplasia in each of the five specimens. Eight of the ten infants are alive without symptoms, the oldest being 27 months. Prevention may require critical analysis of suction techniques and the catheter tips employed. Whistle tip catheters should be avoided. Mild obstructive lesions can be managed by gentle and less frequent suctioning and aggressive pulmonary care, but severe obstruction, as determined by a compromise of the lumen of greater than 20%, may require excision or cauterization.

Critical aortic stenosis in neonates.

Twelve infants with valvular aortic stenosis manifested symptoms of heart failure during the first 2 months of life. Nine became symptomatic and demonstrated cardiomegaly and pulmonary vascular congestion during the first week of life. The other 3 infants became symptomatic at 3-8 weeks. Echocardiograms revealed normal or enlarged left atrial and ventricular dimensions excluding hypoplastic left heart. Left ventriculography demonstrated segmental dysfunction in 7 infants and generalized hypokinesis in 2 others. Trabecular effacement corresponded with the sites of left ventricular dysfunction. Postoperative studies revealed a decrease in cardiac size and improvement in segmental dysfunction in most infants.