Surgical treatment of long-segment tracheal anomalies in infants and children.
BACKGROUND
Tracheal stenosis in combination with vascular and/or cardiac anomalies is a life-threatening condition in infants and children presenting with severe symptoms of airway obstruction. The optimal surgical treatment of these cases remains controversial.


OBJECTIVE
We present here a group of infants and children with combined tracheal malformations and vascular and/or cardiac anomalies. More than 30 % of the stenotic trachea was resected in a subgroup of the patients. A reconstruction with end-to-end anastomosis was achieved on the basis of extensive mobilization of the whole tracheobronchial tree and use of CPB.


METHODS
The clinical outcome in 37 children with a median age of 8 (1 - 72) months was analyzed retrospectively. The patients presented with severe airway obstruction in combination with congenital heart defects and/or vascular anomalies. Cardiac catheterization, bronchoscopy and thoracic computer tomography were performed prior to operation. The operations were performed under CPB and consisted of tracheal resection with end-to-end anastomosis or external stabilization. Associated intracardiac and vascular anomalies were repaired simultaneously.


RESULTS
All but 1 patient survived and had a straightforward recovery. The patients were extubated under bronchoscopic control with a median intubation time after airway repair of 12.2 days. The average follow-up was 8.4 years (1 - 14 years) and the surviving patients did not show signs of restenosis clinically. A segment longer than 30 % of the tracheal length was resected and reconstructed with end-to-end anastomosis in 57 % of the patients (12 of 21 patients).


CONCLUSIONS
Our experience demonstrates that resection of tracheal stenosis and end-to-end anastomosis can be achieved successfully even in cases with stenosis of more than 30 % of the total tracheal length. The use of CBP allowed extensive mobilization of the tracheobronchial tree and resection with end-to-end tension-free anastomotic reconstruction.
Loukanov
T
T
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany. tsvetomir.loukanov@med.uni-heidelberg.de
Gorenflo
M
M
Sebening
C
C
Springer
W
W
Eichhorn
J
J
Ulmer
H
H
Hagl
S
S
D000714:Anastomosis, Surgical / Q000379:methods; D001999:Bronchoscopy; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014132:Trachea / Q000002:abnormalities* / Q000601:surgery; D014135:Tracheal Stenosis / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome