title: Airway obstruction and ventilator dependency in young children with congenital cardiac defects: a role for self-expanding metal stents.
abstract: OBJECTIVE
  Young children with congenital cardiac defect and airway obstruction leading to ventilator dependency present a significant clinical challenge with uncertain outcome.
  
  
  METHODS
  Retrospective review of our experience with self-expanding metal stents in these young children between 1996-2000.
  
  
  RESULTS
  Airway stenting has been undertaken in five such children (four boys, one girl) at our institution. Their mean age was 7.4 months (range 2-14 months), and four of the five had undergone congenital cardiac surgery and could not be weaned from the ventilator following surgery. These five children were ventilator dependent for a mean of 112 days (range 40-210 days, median 71). A total of ten self-expanding metal stents were inserted (4-11 mm in diameter and 15-33 mm in length). The sites stented included the trachea (two stents), the left main bronchus (three stents) and the bronchus intermedius (five stents). Four of these five children were successfully weaned from the ventilator and extubated after a mean time interval of 6 days (range 2-11 days, median 5.5) after stenting. One child failed to wean from the ventilator, required tracheostomy and is ventilator dependent after 8 months. There was one death 2 months after extubation but unrelated to the airway. Three children remain well and asymptomatic 24, 36 and 54 months after stenting.
  
  
  CONCLUSIONS
  Airway stenting in such young children is an infrequent procedure often undertaken in dire circumstances. We have found it valuable in enabling ventilator-dependent children to be extubated with encouraging early results. Their long-term outlook remains uncertain and is dependent on the underlying cardiac status.
authors.affiliation: Thoracic Surgery, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Kumar
authors.forename: Amit
authors.initials: A
authors.lastname: Roy
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Penny
authors.forename: George
authors.initials: G
authors.lastname: Ladas
authors.forename: Peter
authors.initials: P
authors.lastname: Goldstraw
mesh_terms: D000402:Airway Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016084:Bronchoconstriction; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D012121:Respiration, Artificial; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015300:Ventilator Weaning