Treatment Of Congenital Tracheal Stenosis Research Articles

Use of Virtual Reality and Three-Dimensional Printing in the Surgical Planning of Slide Tracheoplasty.

Purpose: To describe our experience using virtual reality (VR) and three-dimensional (3D) printing as complements for the surgical planning process of slide tracheoplasty (ST) in patients with congenital tracheal stenosis (CTS). Description: VR and 3D printing are used for the surgical planning of ST as a therapeutic option in three female patients under five years of age with CTS. Evaluation: We assessed the planned surgical procedure, procedural time, postoperative complications, and outcomes, as well as the main surgeon's experience with the use of the applied technologies. Conclusions: The interaction within the VR environment allowed for collaboration of the surgical plan between surgical staff and enhancement of the radiologist-surgeon communication, while procedural simulation with 3D printing prototypes allowed for refining technical abilities for the surgical interventions. Based on our experience, the application of these technologies have added value to the surgical planning of ST and its outcomes in the treatment of CTS.

Simulated slide tracheoplasty for congenital tracheal stenosis using three-dimensional printed models.

The slide tracheoplasty (STP) is the standard treatment for severe congenital tracheal stenosis (CTS). Understanding the features of the tracheal stenosis in each case and choosing an appropriate incision design are very important for successfully executing the procedure. The present study aimed to evaluate the advantages of three-dimensional (3D) printed models of the trachea for improving CTS. Three-D tracheal models were created using computed tomography (CT) data from ten patients undergoing STP for CTS. Simulated surgery was performed using the hollow models after reinforcing with them with a coating of gum spray. Clinical outcomes, including patient survival, postoperative surgical interventions, and time required for STP, were compared with the corresponding values in the last ten patients before the introduction of 3D model simulations. All ten patients for whom simulated surgery using a 3D tracheal model were conducted achieved good airway patency after their STP. The surgeons reported feeling that the 3D model simulations were highly effective although there was no significant difference in the clinical outcomes of the groups with or without simulated STP. The models were useful not only for surgical planning but also for sharing important information among the multidisciplinary team and the patients' family. Our experience using 3D tracheal models demonstrated several features enabling improvement in the surgical treatment of CTS.

Successful surgical treatment of congenital tracheal stenosis combined with tracheal bronchus and left pulmonary artery sling: a 10-year single-institution experience.

Radical surgery for congenital tracheal stenosis (CTS) is technically demanding. CTS combined with tracheal bronchus (TB) and pulmonary artery (PA) sling is a particularly challenging condition. We herein report our successfully modified surgical techniques for CTS combined with TB and PA sling. Nine patients treated at our institution from July 2010 to December 2020 for CTS with TB and PA sling were enrolled. The patients' characteristics, operative results, and clinical outcomes were reviewed and analyzed retrospectively. The mean age at the operation and body weight were 8.0 ± 4.4months old and 6.5 ± 0.8kg, respectively. The mean tracheal diameter and length of the stenotic lesion were 3.2 ± 1.0mm (mean stenosis rate 46.2%) and 25.4 ± 4.9mm, respectively. All cases were complicated with PA sling at bifurcation stenosis with tracheobronchomalacia. All patients underwent modified posterior-anterior slide tracheoplasty with an inverted Y-shaped incision at the bifurcation and repositioning of the PA. The mean postoperative intubation period was 25.0 ± 32.1days. There were no major intraoperative or postoperative complications, including hypoxic-ischemic encephalopathy. The mean hospital stay was 92.2 ± 73.4days. All patients were discharged home without tracheostomy or oxygen support. Our slide tracheoplasty technique for CTS with TB and PA sling achieved excellent outcomes. Level IV.

Outcomes of slide tracheoplasty for congenital tracheal stenosis in 80 children: A 22-year single-center experience

PurposeThe application of slide tracheoplasty (STP) in the treatment of congenital tracheal stenosis (CTS) has improved patient outcomes over the past few decades. We reviewed our experiences with the procedure, elucidated risk factors, and discussed important aspects of perioperative management to improve outcomes. MethodPatients with CTS undergoing STP between July 1998 and December 2020 were enrolled. Patient characteristics, perioperative condition, management, operative details, and outcomes, including mortality and postoperative intervention, were collected from medical records. ResultsEighty patients underwent STP. Sixty-five patients (81.3%) had an associated cardiovascular anomaly. Thirteen patients (16.3%) had unilateral lung agenesis or hypoplasia. Preoperative mechanical ventilation was necessary in 54 (67.5%) patients, and extracorporeal membrane oxygenation (ECMO) was required in eight patients (10.0%). An endotracheal tube was placed before the stenotic entrance to avoid granulation. During STP, the trachea was dissected as little as possible to maintain the blood supply. The one-year survival rate was 88.8% (nine patients died). One patient (1.3%) required postoperative balloon dilation, and none required stenting or granulation removal. Of the survivors, 62 (92.5%) achieved successful extubation without tracheostomy. Multivariable analysis revealed complex cardiovascular anomaly (P = 0.05) and preoperative ECMO (P = 0.019) to be adverse predictors of survival. ConclusionAlthough STP can be performed successfully in CTS patients, surgeons and families should be aware of factors that may lead to a more difficult postoperative course or increase the mortality. Meticulous, perioperative positioning of the endotracheal tube and preserving the tracheal blood flow can minimize the need for postoperative intervention.

Non-operative management of congenital tracheal stenosis: criteria by computed tomography.

Whether to perform surgical or conservative treatment for congenital tracheal stenosis (CTS) is controversial. Thus, the computed tomography (CT) criteria for conservative treatment of CTS were investigated. From 2005 to 2017, 28 CTS cases were included. The operative cases and preoperative death cases constituted the required intervention group (group I), and the non-operative surviving cases constituted the observation group (group O). The diameter of the tracheal narrowest part (DTNP) on CT was evaluated as a criterion for non-operative follow-up. Chest CT was performed 19 times in 19 group I cases and 18 times in 9 group O cases. The median age of the patients that underwent CT scan examinations was 3.4months (range 0-25months) in group I and 22months (range 0-60months) in group O. The cut-off values of the non-operative criteria were 40.8% (AUC: 0.82, p < .01) normal for age of the trachea's narrowest part, and 41.6% normal for body weight (AUC: 0.92, p < .01), respectively. DTNP is 40% and more of the normal diameter appears necessary for non-surgical management. The present study suggests that the criteria for conservative management of CTS are that the DTNP is not less than 40% of the normal tracheal diameter, with a few symptoms.

Bronchial Mismatch as a Predictor of Respiratory Failure After Congenital Tracheal Stenosis Repair

The purpose of this study was to identify predictors of postoperative respiratory failure after surgical tracheoplasty for congenital tracheal stenosis. Between February 2011 and April 2017, 16 infants underwent congenital tracheal stenosis repair. Preoperative computed tomography evaluation of the trachea and mainstem bronchi was performed. The primary outcome was midterm freedom from postoperative respiratory failure defined as persistent need for mechanical ventilation or surgical tracheobronchial reoperation. Bronchial mismatch, defined as [1- (smaller bronchus diameter / larger bronchus diameter)]× 100, was analyzed in relation to the primary outcome. Median age was 106 days (range, 1 to 406) and median weight was 5.3 kg (range, 2.6 to 8 kg). Four patients were neonates (25%) and 6 had genetic abnormalities (37.5%). There were no early nor late deaths. Median ventilation time was 5.5 days (range, 3 to 45). Mean follow-up time was 2.2 years (range, 0.1 to 4.5). Four patients with bronchial mismatch greater than 20% had postoperative respiratory failure (p= 0.002). Two of them underwent tracheostomy and were discharged with ventilation home care support. One underwent successful reoperation consisting of bilateral bronchial plasty with autologous cartilage rib grafts, and the other underwent successful right bronchial and tracheal reconstruction. One patient with bilateral bronchial hypoplasia underwent slide tracheoplasty associated with preemptive bilateral bronchial plasty and made a full recovery. Surgical treatment of congenital tracheal stenosis in neonates and infants portends a good outcome. Bronchial mismatch greater than 20% can identify a subset of patients at increased risk for surgical reintervention and chronic respiratory failure. Slide tracheoplasty with preemptive bronchial reconstruction may prevent postoperative respiratory failure.

Complex surgical treatment of congenital tracheal stenosis with associated unilateral lung agenesis

Abstract Background The combination of congenital tracheal stenosis (CTS) and unilateral pulmonary agenesis is rare and fatal. Especially, right lung agenesis is associated with dextrocardia and often causes tracheal alignment disorder. The mortality is estimated with 12.5–65%. Slide Tracheoplasty (ST) has been improved the prognosis, however, the postoperative course of CTS with single lung remains unclear. Here, we describe the postoperative challenging situation with bronchial intervention and other devices. Case presentation A 9-month-old girl with CTS, right lung agenesis, dextrocardia, and bilateral superior vena cava underwent ST anterior to the aortic arch. On postoperative day 50, tracheostomy was performed for long-term airway pressure support. Six months after the ST, she showed severe bronchomalacia at the bifurcation of the lobar bronchi, which was sandwiched between the descending aorta and left pulmonary artery. Direct bronchopexy and mobilization of left pulmonary artery resolved the severe bronchomalacia. Additionally, the kinked trachea caused a tracheal ulcer and frequent accidental decannulations. The ulcer was made above the aortic arch by contact with the tracheal cannula. The customized Montgomery T-tube solved both problems and enabled the stable management for airway. Her condition eventually improved, and she was discharged home after 14 months of hospitalization. Conclusion This case presented a very rare and critical condition. This is the first report to address the severe condition after ST anterior to the aortic arch. Surgical interventions or other devices for treatment are thought to be modified according to each condition.

Operative or non-operative treatment of congenital tracheal stenosis: is there something new?

In the 2015, 8th issue of the International Journal of Clinical and Experimental Medicine , HONG et al . (1) focus on the non-operative treatment of congenital tracheal stenosis (CTS) associated with left pulmonary artery sling (PAS).

One-stage surgical correction of congenital tracheal stenosis complicated with congenital heart disease in infants and young children.

Although the outcome of surgical treatment of congenital tracheal stenosis (CTS) has improved, surgical intervention for these patients, especially for those with associated congenital heart disease (CHD) remains challenging. In this report, we summarized our experience with these defects. Clinical data were collected for children undergoing tracheoplasty and CHD surgery from January 2001 to March 2013. Bivariate and multiple regression analyses were used to determine the correlation between the variables. Forty-three patients underwent simultaneous repair of CTS and CHD. Their ages ranged from two months to nine years (mean 23.16 months) and weights from 3.5 to 46.1 kg (mean 10.71 kg). Associated CHD included pulmonary artery sling (n = 31), tetralogy of Fallot (n = 5), ventricular septal defect (n = 4), atrial septal defect (n = 4), double aortic arch (n = 2), and pulmonary atresia with ventricular septal defect (n = 1). Five patients underwent simple tracheal resection, eight patients underwent tracheal autograft, and 30 patients received slide tracheoplasty. There were seven deaths, five early and two late; the most common cause was the growth of granulation tissue. In bivariate analysis, the length of tracheal stenosis (p < 0.01), age (p < 0.01), and complications (p < 0.01) were associated with mortality. Shorter duration of postoperative mechanical ventilation (p < 0.05) and less serious complications (p < 0.05) were associated with slide tracheoplasty. The percentage of slide tracheoplasty was higher in long-segmental and diffuse tracheal stenosis (p < 0.01). Slide tracheoplasty is the best option for surgical treatment of long-segmental and diffuse tracheal stenosis. Simultaneous repair of associated CHD did not increase the complication rate and is the procedure of choice for patients with combined CTS and CHD.

Balloon tracheoplasty as initial treatment for neonates with symptomatic congenital tracheal stenosis.

Neonates with congenital tracheal stenosis (CTS) sometimes develop respiratory distress and may be difficult to intubate. We used balloon tracheoplasty with a rigid bronchoscope for emergency airway management in neonates with symptomatic CTS. Herein, we describe the balloon tracheoplasty procedure and the early outcomes following its use as the initial treatment of neonatal symptomatic CTS. We performed a retrospective analysis of five neonates with CTS who were initially treated with balloon tracheoplasty at our institution from January 2010 to December 2013. Five patients with a mean birthweight of 2,117g were treated during the study period. Of these, four developed respiratory distress after birth, and all patients had difficult intubations. In all five patients, definitive diagnosis of CTS was made by rigid bronchoscopy and 3-dimensional reconstruction scan. A total of nine balloon dilatations were performed in five patients. Following balloon tracheoplasty, two patients were extubated, one was extubated after resection and end-to-end anastomosis following initial balloon dilatation, and one remained hospitalized with tracheostomy for tracheomalacia. The remaining patient died from tracheal bleeding associated with congenital heart disease. Although our sample size was small, balloon tracheoplasty is a potentially effective initial treatment for selected cases with neonatal symptomatic CTS.

Treatment of congenital tracheal stenosis by balloon-expandable metallic stents in paediatric intensive care unit

The aim of this study was to evaluate the use of balloon-expandable metallic stents in the treatment of children with congenital tracheal stenosis in whom conventional therapy has failed. From 2010 to 2011, balloon-expandable metallic stents were implanted into the trachea of eight infants aged 2-20 months in the paediatric intensive care unit. The infants had severe airway obstruction caused by congenital tracheal stenosis. Tracheal stents were placed after intraluminal balloon dilatation of the tracheal stenosis, inserted with balloon catheters and implanted into the desired position bronchoscopically. The stents were 12 to 29 mm long and 4 mm in diameter. Seven children were relieved of airway obstruction after this procedure. However, a child died due to severe sepsis after the placement of bronchial stents. No granulation tissue developed over the stents in any of the children. Stents have been in place for 1-6 months after insertion without any other complication. Balloon-expandable metallic stents are effective in relieving airway obstruction by congenital tracheal stenosis in children. This technique may provide an important remedy for congenital tracheal stenosis in children.

Severe airway obstruction in an infant with congenital tracheal stenosis and congenital heart disease -A case report-

Congenital tracheal stenosis (CTS), though rare, is important because the mortality and morbidity rates are high in infants. Especially, associated congenital heart disease (CHD) in these infants may compound the effects of airway pathology. A 3-week-old patient with long-segmental tracheal stenosis below an anomalous right-upper lobe (RUL) bronchus had undergone a total correction of double outlet right ventricle. On third postoperative day, hypercarbia developed, and severe airway obstruction and atelectasis were detected. An emergency slide tracheoplasty was performed under cardiopulmonary bypass (CPB). The patient recovered well after the surgery. Thus, special attention needs to be paid during the postoperative intensive care of patients with congenital tracheal anomalies. Early detection and prompt diagnosis of airway obstruction can help reduce the morbidity and mortality rates. Further, it is important to select the suitable treatment of CTS associated with CHD.

Management of symptomatic congenital tracheal stenosis in neonates and infants by slide tracheoplasty: a 7-year single institution experience

Congenital tracheal stenosis (CTS) is rare. When it presents early in life, its management can be challenging. Of the surgical techniques that have been devised to correct long-segment CTS, slide tracheoplasty (ST) appears to be superior. We present our 7-year-experience of ST for the treatment of symptomatic CTS in neonates and infants. The hospital records of all 14 neonates and infants who underwent ST between 2001 and 2008 at our hospital were retrieved. Patient characteristics, trachea morphology, co-existing anomalies, operative procedures, techniques, outcomes and clinical courses were reviewed. Patients underwent ST at age 4 days to 22 months (median: 2.4 months). Five (36%) required intermittent ventilator support prior to surgery. All ST was done under cardiopulmonary bypass. The associated cardiovascular anomalies in 10 infants (71%) were also corrected at the same operation. All survived the initial surgical procedures. The in-hospital mortality for the group was 14.3%. The median periods of postoperative intensive care unit and hospital stay of the 12 children, who were successfully extubated within 7 postoperative days, were 9 days (range: 6-28 days) and 28 days (range: 14-375 days), respectively. Follow-up of all 12 midterm survivors was complete, ranging from 5 months to 5.6 years (median: 40 months). A total of four patients had been found to have tracheobronchial malacia postoperatively and were managed with stenting. Of the remaining 10 survivors who had no residual or recurrent airway problems, and no cardiovascular residuum or sequela, two had gross developmental delay. In the management of symptomatic infants with CTS, our limited experience suggests that meticulously performed ST together with vigilant pre- and postoperative care can provide satisfactory short and midterm solution to the airway problem. Some incidental residual clinical problems appear to be unavoidable.

Treatment of Congenital Tracheal Stenosis

Congenital tracheal surgery is uncommon and few centers have enough experience to make meaningful conclusions about treatment. Short-segment congenital tracheal stenosis is treated by tracheal resection, whereas long-segment stenosis is treated by slide tracheoplasty. Tracheomalacia is treated most commonly by aortopexy if due to simple vascular compression, division of an offending vascular ring if due to a compressing or encircling ring, or by careful observation if not associated with vascular compression.

B-040 Tracheobronchial stenting for the treatment of congenital tracheal stenosis : Long-term outcome and problems(Oral Presentation Thoracic surgery,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

B-040 Tracheobronchial stenting for the treatment of congenital tracheal stenosis : Long-term outcome and problems(Oral Presentation Thoracic surgery,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

Prognostic factors in the surgical treatment of congenital tracheal stenosis: A multicenter analysis of the literature

Background Congenital tracheal stenosis (CTS) often requires urgent surgical intervention. We evaluated prognostic factors to determine the risks of surgical interventions by conducting a retrospective review of recent case series. Methods Cases of CTS between 2002 and 2004 from our institution and recently published series that provided primary data on the demographics, complications, and outcomes of patients with CTS were analyzed. Univariate, model fit, and multivariate logistic regression analyses were performed using the SAS Statistical Program. Results There were 68 patients who were treated (cartilage patch tracheoplasty, n = 31; slide tracheoplasty, n = 37), with 19 deaths (overall mortality = 28%). A total of 10 patients who underwent cartilage patch tracheoplasty died (32% mortality), whereas only 9 patients died following slide tracheoplasty (24% mortality). A total of 8 of 11 patients who were repaired at the age of 1 month or younger died (73% mortality), whereas only 11 of 57 patients who were repaired at an age older than 1 month died (19% mortality) ( P = .04). A total of 10 of 19 patients with CTS who had comorbid intracardiac anomalies died following CTS repair (53% mortality), whereas only 9 of 49 patients with CTS who did not have intracardiac anomalies died (18% mortality) ( P = .02). Conclusions This is the first report on the prognostic factors determining surgical outcomes for CTS. The highest mortality rate was observed in CTS patients younger than 1 month and in those with intracardiac anomalies. Congenital tracheal stenosis repairs in these patient subgroups should be considered with caution.

Treatment of Congenital Tracheal Stenosis with Balloon-assisted Posterior Tracheal Splitting and Temporary Placement of a Covered Retrievable Metallic Stent

Balloon tracheoplasty and temporary placement of a covered retrievable self-expandable metallic stent was successfully undertaken in the treatment of congenital tracheal stenosis from complete cartilaginous rings in an infant. After balloon tracheoplasty and temporary placement of the stent for 5 months, stable airway condition has been maintained for 21 months.

Management of congenital tracheal stenosis.

Congenital tracheal stenosis is a rare disease. Various methods for treatment exist but there is still much debate as to the appropriate surgical procedure. We present our surgical experiences of patch tracheoplasty and slide tracheoplasty as viable methods for the treatment of congenital tracheal stenosis. From 1994 to 2002, 13 patients were diagnosed with congenital tracheal stenosis. Eight patients (7 symptomatic and 1 asymptomatic) had their stenosis corrected, three by means of pericardial patch tracheoplasty, four by slide tracheoplasty, and one by resection and anastomosis. Concomitant operations were performed on six patients to treat congenital cardiovascular disease. Five patients showing no significant symptoms did not undergo tracheal surgery and received only cardiac procedures. A retrospective review of the hospital course, complications, and long-term results was conducted. Among the patch tracheoplasty group, every patient suffered from granulation tissue formation. One patient died of respiratory acidosis and one was hospitalized due to recurrent granulation tissue, which required frequent bronchoscopy. The third patient from this group is free of all symptoms. Among the slide tracheoplasty group, one patient died of anastomosis disruption. The three remaining patients are alive and well. The one patient who received resection and anastomosis is alive without symptoms. Surgical repair of long-segment congenital tracheal stenosis exhibited high mortality and morbidity rates. Every patient that underwent pericardial patch tracheoplasty suffered from troublesome granulation tissue. As slide tracheoplasty provided relatively good results in the short and mid-term follow-up periods, it seems to be a preferred method for the treatment of long-segment congenital tracheal stenosis.

A new approach to the treatment of congenital tracheal stenosis: Balloon tracheoplasty and expandable metallic stenting

Background/Purpose: Many surgical procedures have been unsatisfactory for the treatment of congenital tracheal stenosis. The authors used intraluminal balloon dilatation and expandable metallic airway stent for this condition. Methods: From 1997 to 2000, balloon expandable stents (Palmaz) were inserted into the trachea in 5 infants, aged 7 days to 12 months who had severe airway obstruction caused by tracheal stenosis. Tracheal stents were placed after intraluminal balloon dilatation of complete tracheal rings. The stents were placed on balloon catheters and were inserted into the desired position bronchoscopically using x-ray control. They were expanded and fixed in place by inflating the balloon to appropriate diameter. The stents were 10 to 40 mm long and 6 to 8 mm in diameter. Results: Four patients have been relieved of airway obstruction after this procedure. One patient died after 9 months of palliation. In all patients, granulation tissue developed over the stents and could be managed by scraping or balloon compression. Stents have been in place for 9 to 36 months after insertion without any other complication. Conclusions: Airway stents after balloon tracheoplasty can be left for prolonged periods to relieve tracheal obstruction. This technique may provide an important remedy in infants and children with congenital tracheal stenosis. J Pediatr Surg 36:1646-1649. Copyright © 2001 by W.B. Saunders Company.

Rib-muscle pedicle flap for the repair of congenital tracheal stenosis.

Congenital tracheal stenosis (CTS) is an uncommon congenital anomaly that presents early in life with symptoms of biphasic stridor. Most cases require surgical correction. Techniques have included dilation, resection of the involved segment, and tracheoplasty. Today pericardium and costal cartilage are the most frequently used materials for tracheoplasty, but patients still often encounter problems with the graft, with the procedure, or with late complications. This preliminary study was undertaken to determine the feasibility of a rib-intercostal muscle pedicle flap for the treatment of CTS. Tracheoplasties were performed on seven 3.5- to 5.5-kg piglets with a pedicled segment of the right fourth rib via a lateral thoracotomy incision. The method was found to be technically feasible, and pedicles of greater than 2.5 cm were easily developed. The repair provided good structural support and an airtight seal at high ventilator pressures. Histologic examination after 2 weeks showed the flap to be incorporating into the native trachea and to be without degenerative changes. This "vital" composite flap has several real and theoretic advantages over current methods of repair and may prove to be valuable in the treatment of CTS. The clinical application of this myo-osseous pedicle graft in the treatment of patients with stenoses not amenable to surgical resection and primary anastomosis should be explored.