Airway Pathologic Abnormalities in Symptomatic Children With Congenital Cardiac and Vascular Disease

Abstract

Objective: To identify the epidemiological profile of airway abnormalities in symptomatic children with cardiac or vascular anomalies.Design: Retrospective medical chart review.Setting: Tertiary referral pediatric hospital.Patients: Children with airway-related symptoms and coexistent cardiac or vascular abnormality were included. The source for patient identification was a prospectively kept database.Main Outcome Measures: Endoscopic airway diagnoses, presenting airway symptoms, cardiac diagnoses, other comorbid conditions and pertinent diagnoses, patient demographics, source of referral, treatments, and follow-up. Results:The study population comprised 77 patients (45 male and 32 female; mean age, 18.2 months) treated between June 2002 and July 2006. Only 4 patients had no findings. The most common airway abnormality was laryngeal paralysis (n=32), followed by subglottic stenosis (n=18). Congenital and acquired lesions were equally encountered (n=70 and n=64, respectively). The most frequent presentation was intolerance to feed (n=51) (stridor and/or failure of extubation). Of the 77 patients, 32 (42%) required airway surgical intervention (open vs closed); 36 (47%) still require otolaryngologic followup; and 32 (42%) had a named syndrome or general multisystem condition.Conclusions: At least 3% of all children with cardiac disease will harbor airway problems. Laryngeal paralysis was the most common problem encountered. Given the successes achievable in treating children with complex cardiac abnormalities, attention should be paid to concomitant and consequential airway problems. Counseling processes should acknowledge the role of early otolaryngologic involvement.

Flexible bronchoscopy in pulmonary diseases in children with congenital cardiovascular abnormalities

“…1). Failure to extubate was defined as two or more failed attempts to extubate or failing to meet the criteria for extubating (2).…”

“…Although respiratory diseases, particularly infections, are common in children, occasionally, they may be life-threatening if those suffering from congenital cardiovascular abnormalities are affected (1). Furthermore, ≥3% of children with cardiac disease also exhibit airway issues, including tracheobronchomalacia and airway narrowing, which are known to be latent causes and aggravating factors of persistent and recurrent lower respiratory infections (2,3). A rapid and accurate diagnosis is essential for the initiation of appropriate treatment in children presenting both pulmonary diseases and congenital cardiovascular abnormalities (1).…”

Noninvasive Imaging Study of Tracheobronchial Compression Caused By Tortuosity and Dilation of the Thoracic Artery

“…In children with persistent recurrent respiratory distress, unexplained atelectasis, or extubation failure, the possibility of airway compression should be strongly suspected [13][14][15][16]. In this study, the findings imply that the location of tracheobronchial compression caused by tortuous and dilated large and medium-sized thoracic arteries can be very different.…”

Tracheostomy in Infants With Congenital Heart Disease: A Nationwide Population-Based Study in Taiwan

“…[1][2][3] Progress in neonatology, intensive care, pediatric cardiology, and cardiovascular surgery means that CHD is no longer considered fatal, and favorable outcomes can often be achieved. 4 Therefore, it is crucial to explore the risk factors associated with CHD morbidity and mortality to optimize quality of life.…”