Airway compression in children with congenital heart disease evaluated using computed tomography.
BACKGROUND
Extrinsic airway compression often complicates the course of congenital heart disease (CHD) repair. This study investigated the risk factors and outcome of airway compression evaluated using computed tomography (CT) in CHD patients.


METHODS
Of the 2,729 patients who underwent heart surgery for CHD between 1999 and 2007, airway compression was confirmed using CT in 58 (2.1%) patients. The patients were divided into groups according to the underlying CHD, and their medical records and CT scans were reviewed retrospectively.


RESULTS
Airway compression was found more frequently in the vascular ring or absent pulmonary valve syndrome (8 of 11) and repaired aortic arch (22 of 213) groups than in the other groups (28 of 2,505) (p < 0.001). Patients with more severe respiratory manifestations showed greater airway compression on CT (p < 0.001) and had a higher rate of additional surgery to relieve airway compression using multivariate analysis (p = 0.005). Airway compression was ameliorated in 13 of 17 patients after surgery for airway compression. Funnel chest deformity worsened after aortic arch repair and was associated with the need for surgical relief of airway compression. Pulmonary overflow disease could be followed up without additional surgery for airway compression.


CONCLUSIONS
Early airway compression detection and management may reduce further morbidity, especially after aortic arch repair. The patient's respiratory manifestation and the underlying disease characteristics must be considered when determining the need for additional surgery for airway compression.
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.
Hyo Soon
HS
An
Eun Young
EY
Choi
Bo Sang
BS
Kwon
Gi Beom
GB
Kim
Eun Jung
EJ
Bae
Chung Il
CI
Noh
Jung Yun
JY
Choi
Woong Han
WH
Kim
Jeong Ryul
JR
Lee
Yong Jin
YJ
Kim
Eun-Ah
EA
Park
Whal
W
Lee
D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
20; AA group; AC; AC ratio; Additional SAC; CHD; CT; FC ratio; Group 1; Group 2; IA ratio; LRS group; RVOT group; SAC; SAC after first surgery for underlying heart disease; VR group; airway compression; computed tomography; congenital heart disease; funnel chest deformity ratio; interaortic distance ratio; pulmonary overflow disease (left to right shunt) group; ratio of the compressed airway diameter to the trachea; reconstruction of the right ventricular outflow tract group; repaired aortic arch group; surgery for airway compression; vascular ring or absent pulmonary valve syndrome group; with SAC (2A = simultaneous, 2B = additional); without SAC