Tracheoplasty for Congenital Complete Tracheal Rings

Congenital long segment tracheal stenosis presenting with tachypnea

“…Although some authors recommend the use of flexible bronchoscopy as the principle method of diagnosis, we agree with Andrews et al (6) that rigid instrumentation provides added safety to airway management, which is important when investigating a marginal airway. Such a bronchoscopy should be performed where facilities are available for complex airway management.…”

Slide Tracheoplasty for Long-Segment Tracheal Stenosis

“…14 A major problem with augmentation tracheoplasty using costal cartilage is the need for multiple bronchoscopies due to recurrent granulation tissue formation at cartilage graft sites. 2 The decreased duration of stenting associated with the single-stage approach seems to lessen this problem.…”

“…This experience has been subsequently updated, 16,17 and this technique has been used and reported on by other investigators as well. 2,18,19 Pericardial patch augmentation tracheoplasty requires extracorporeal circulation, complete sternotomy, and wide exposure of the trachea via a transpericardial approach. The stenotic trachea is incised vertically and the pericardial patch sutured into place; the patch is suspended to the innominate artery and the artery is suspended to the sternum.…”

“…21 A more recent review of 18 patients with congenital tracheal stenosis, 15 of whom were treated surgically, reveals the mortality of this disorder to remain quite high at 47%. 2 The largest series assessing pericardial patch augmentation tracheoplasty documents a significantly improved mortality of only 17% in a notably high-risk population; 25% of the patients still required tracheotomy after tracheal reconstruction for either clearance of secretions or distal stenting. 17 Tracheal involvement within 1 cm of the carina or involvement of either mainstem bronchus increased the risk of tracheotomy tube dependence and the likelihood of fatal outcome.…”

“…Three morphological subtypes are described: (1) short-segment stenoses involving varying lengths of the trachea, (2) funnel-like long-segment stenoses in which portions of the proximal and the distal trachea may be spared, and (3) generalized long-segment stenoses extending over the entire trachea from cricoid to carina with potential associated mainstem bronchi involvement. 1 Congenital tracheal stenosis may exist as an isolated entity or in conjunction with other anomalies, particularly the pulmonary artery sling complex.…”