Surgical treatment of airway obstruction associated with congenital heart disease in infants and small children

Abstract

In the last 12 years, 21 patients age 1 month to 5 years (median, 7 months) underwent surgical treatment for severe airway obstruction associated with congenital heart disease. Plico-suspension of the pulmonary artery was carried out in 14 patients with documented severe left bronchial compression by a distended pulmonary artery together with repair of ventricular septal defects (11 patients), repair of large coronary artery fistula (1), division of ductus (1) and pulmonary artery banding (1), with subsequent significant relief of compression. Aortopexy was used in 2 patients with documented severe tracheal compression by a right aortic arch. Five patients had congenital tracheal stenoses (3 extensive, 2 localized). Two of 3 patients with associated complex intracardiac anomalies underwent concomitant repair of both lesions with the use of cardiopulmonary bypass and 1 had a tracheoplasty and pulmonary artery banding. Tracheal reconstruction with a cartilaginous graft together with repair of pulmonary artery sling was carried out in 2 infants. Nineteen patients are alive and well, at a mean follow-up of 87 months. In conclusion, we advocate early aggressive surgical intervention to both lesions to obtain a better result in the management of infants and small children with this difficult and often fatal combination.

Recent challenges in the management of congenital tracheal stenosis: an individualized approach

“…As such, extensive preoperative assessment including genetic analyses should be undertaken whenever possible for counseling parents on palliation as an alternative to operative management. Although one report suggests that patients with CTS and with complex cardiac anomalies can be managed successfully with concomitant repairs [9], our results suggest otherwise. Significant cardiac anomalies such as atrioventricular septal defects can be lethal when associated with a second congenital anomaly.…”

Prognostic factors in the surgical treatment of congenital tracheal stenosis

“…Although some individual centers have reported success in the simultaneous surgical correction of CTS and cardiac defects [1,8,14], excluding patent ductus arteriosus and vascular slings [15,16], our data suggest that the coincident diagnosis alone poses a significant morbidity and mortality risk. In our limited experience, the development of refractory pulmonary hypertension resulted in cardiac failure in our CTS patients with endocardial cushion defects.…”

Translocation of dilated pulmonary artery for relief of bronchial compression associated with ventricular septal defect

“…Treatment for major airway obstruction associated with congenital heart defects in infancy is variable [4][5][6][7][8]. In our case, the stretched and dilated right pulmonary artery was considered to be a conclusive cause of airway obstruction as follows.…”

“…It was essential to repair the malposition of pulmonary artery and unbalanced pulmonary blood flow. In fact, the mortality and residual postoperative respiratory problems in infants who had had repair of the cardiac defect concomitant along with repair of bronchial compression are low as compared to infants who had had only repair of the cardiac defect [7].…”

“…The relationship between the tracheobronchial tree and the anomalous vascular structure, and abnormal hemodynamics by cardiac anomaly cause airway obstruction [2,6]. Even a mild degree of extrinsic compression of the bronchi in infants results in airway obstruction because bronchial luminal resistance is inversely proportional to the fourth power of radius of the lumen [1,7].…”