title: A new morphologic classification of congenital tracheobronchial stenosis.
abstract: BACKGROUND
  Congenital tracheal stenoses are rare and life-threatening anomalies, associated with considerable variation in both morphology and prognosis. They have been classified previously according to the length of the stenosis or the severity of the symptoms, but not according to bronchial involvement.
  
  
  METHODS
  Data from patients who underwent slide tracheoplasty for long-segment (>50%) congenital tracheal stenosis were collected. We identified four different types of bronchial arborization (normal, n=52; tracheal right upper lobe bronchus, n=10; carina with "trifurcation," n=14; and unilateral bronchial and lung agenesis, n=8). Each type included congenital tracheal (above the carina) or tracheobronchial (extending below the carina) stenosis.
  
  
  RESULTS
  Eighty-four children were enrolled in the study. Preoperative ventilation was necessary in 44 patients (52.4%; 75% in patients with a single lung), and preoperative extracorporeal membrane oxygenation was needed in 10 patients (11.9%). Preoperative tracheostomy was present in 3 patients initially treated elsewhere (3.5%), and a left pulmonary artery sling was performed in 44% (37 of 84). The overall mortality was 13% (11 of 84), 7.9% in patients with tracheal stenosis and 28.6% with tracheobronchial stenosis. No deaths occurred in patients with right upper lobe bronchus anatomy. Endoscopic procedures after slide tracheoplasty were required in 34 patients (40.4%). Stents were placed in 18 patients (21.4%), with a higher incidence in those with bronchial trifurcation (42.8%, 6 of 12).
  
  
  CONCLUSIONS
  This classification appears useful for the morphologic characterization of congenital airway stenosis and could be the benchmark for future prospective studies on the outcome of these patients.
authors.affiliation: The National Service for Severe Tracheal Disease in Children, The Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom. simone.speggiorin@gmail.com
authors.forename: Simone
authors.initials: S
authors.lastname: Speggiorin
authors.forename: Michele
authors.initials: M
authors.lastname: Torre
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roebuck
authors.forename: Clare A
authors.initials: CA
authors.lastname: McLaren
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Elliott
mesh_terms: D001980:Bronchi / Q000002:abnormalities* / Q000473:pathology*; D003251:Constriction, Pathologic / Q000145:classification* / Q000151:congenital / Q000473:pathology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014132:Trachea / Q000002:abnormalities / Q000473:pathology