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At least 55 records · Page 3Linked to original sources

PubMed2006

Long-term outcomes of clinically significant vascular rings associated with congenital tracheal stenosis.

AIM: Congenital tracheal stenosis (CTS) associated with vascular rings (VRs) is considered a secondary condition, but relative indications for selective VRs or combined VR and CTS repairs are unclear. Here, we report long-term outcomes after VR repair associated with tracheal narrowing (TN). METHOD: Retrospective analysis of patients admitted to a single institution with VR from 1982 to 2004. Of 131 patients with VR (Cardiac Registry Database), 29 (19 males, 10 females; age range, 0 days-4 years) associated with symptomatic TN. Patients were followed until age 18 years. RESULTS: One hundred thirty-one patients with VR were categorized into 3 treatment groups. There were 102 patients with VR with no symptomatic TN treated by VR repair (4 deaths, 4% mortality). Of the 29 patients with VR + TN symptoms, 16 were treated by selective VR repair (mean age, 5.3 months; range, 17-288 days) with 3 deaths (19% mortality) and 13 underwent combined VR and CTS repairs (mean age, 11 months; range, 1 day-4 years) with 6 deaths (46% mortality), for an overall mortality of 31% (P < .01, chi2 test). Of the 102 patients with VR, 17 had intracardiac anomalies with 3 deaths (18% mortality). In contrast, 7 of 29 patients with VR with TN and intracardiac anomalies died (57% mortality); 3 patients in combined cardiac and CTS repairs (2 deaths, 67% mortality) and 4 in selective VR repairs (2 deaths, 50% mortality). CONCLUSIONS: Not all cases of TN associated with VR require combined repairs. The presence of TN and/or intracardiac anomalies in patients with VR, however, increases mortality risk to the repair of VR. Surgical decision requires individualized clinical pathway.

Abnormalities, Multiple↗

PubMed2001

Congenital tracheal stenosis treated with dilatation.

Congenital tracheal stenosis is a rare anomaly characterized by a broad spectrum of variations. Affected segments differ in the grade extent of stenosis, from thin webs to more severe stenoses such as short-segmental, funnel-like, or long-segment tracheal stenosis. A 5-month-old infant with persistent congenital stridor and acute respiratory distress is presented. Radiographic and tracheobronchoscopic investigations confirmed the diagnosis of congenital tracheal stenosis without associated vascular, pulmonary or gastrointestinal anomalies. The stenosis was of a fibrous nature and segmental morphology affecting the initial tracheal section. Dilatation was performed by a rigid tracheobronchoscope with favorable outcome. The reported case was classified into class 1 lesions, which are associated with low mortality and good prognosis. Dilatation performed with a rigid bronchoscope proved to be a rational therapeutic approach in this case. The possible diagnostic and other therapeutic approaches to congenital tracheal stenosis are also discussed.

Bronchoscopy↗

PubMed1977

An endoscopically-introducible T-tube for tracheal stenosis.

Five cases of tracheal stenosis are presented, and aspects of etiology and pathophysiology of the disease are discussed. A new soft, flexible T-tube is described along with a method of endoscopic introduction. Although many patients with tracheal stenosis will eventually need tracheal reconstruction, stenting may be definitive in selected cases.

Adult↗

PubMed1990

Tracheal stenosis.

A case report of tracheal stenosis is used to review the pathophysiology and surgical management of symptomatic tracheal stenosis following intubation and/or tracheostomy. The authors discuss tracheal resection and reconstruction, the preferred permanent method of managing benign tracheal stenosis.

Humans↗

PubMed2004

Single-stage tracheal resection for severe tracheal stenosis in older children.

OBJECTIVE: While tracheal resection for management of tracheal stenosis is an effective technique that has been well described in adults, the results in children have been less encouraging, as children tolerate anastomotic tension less well than adults. We describe our current technique for the management of severe tracheal stenosis in older children. METHODS: Four teenagers, 16-17 years of age, presented with severe tracheal stenosis. A 16-year-old girl had sustained tracheal stenosis following prolonged intubation, and presented with a severe Grade III stenosis having had 25 endoscopic procedures, and a failed resection at another institute. Two 17-year-old boys and a 17-year-old girl presented with Grade IV stenosis at the suprastomal area following previous intubation injuries. All four children had an identical procedure with tracheal resection over a Hood tracheal stent. RESULTS: All four children were extubated in the operating room. Chin-to-chest sutures were removed between 7 and 10 days, as was the Hood stent. All four are currently asymptomatic with no airway stenosis. CONCLUSIONS: Although tracheal resection for tracheal stenosis in children is associated with a higher failure rate than is seen in the adult population, even severe stenosis and long segment resection may achieve excellent results. We feel that important factors influencing outcome in this series included anastomosis to an intact cricoid ring, and support of the anastomosis with a tracheal stent.

Adolescent↗

PubMed1994

Congenital tracheal stenosis. The otolaryngologist's perspective.

Congenital tracheal stenosis is a rare congenital anomaly, with less than 70 reported cases in the literature. The presenting signs and symptoms of stridor, recurrent pneumonia, and respiratory distress are commonly seen in other conditions. The rarity of congenital tracheal stenosis and the diverse presentations make accurate early diagnosis difficult and frequently lead to inappropriate treatment. We treated three patients with congenital tracheal stenosis who presented with different sites of stenosis. Each patient displayed different symptoms and required individualized management. The treatment of congenital tracheal stenosis depends on identifying the site and extent of the stenosis. We reviewed the embryogenesis and treatment of this abnormality and developed a new classification system that will aid in the management of congenital tracheal stenosis.

Female↗

PubMed1986

Experience with tracheal resection for traumatic tracheal stenosis.

Ten patients with traumatic tracheal stenosis--unresponsive to conservative therapy--underwent tracheal resection. Two of the stenoses resulted from gunshot injuries, three were due to prolonged intubation, and five developed after tracheotomy. Eight of the operations were completely successful. There was one death, and one patient has had recurrent granulation tissue at the anastomotic site. The pathogenesis of tracheal stenosis, as well as its treatment--including the technical details of tracheal resection--are discussed.

Adult↗

PubMed2005

Treatment of congenital tracheal stenosis with balloon-assisted posterior tracheal splitting and temporary placement of a covered retrievable metallic stent.

Balloon tracheoplasty and temporary placement of a covered retrievable self-expandable metallic stent was successfully undertaken in the treatment of congenital tracheal stenosis from complete cartilaginous rings in an infant. After balloon tracheoplasty and temporary placement of the stent for 5 months, stable airway condition has been maintained for 21 months.

Alloys↗

PubMed2006

Allograft tracheoplasty technique for management of refractory tracheal stenosis.

OBJECTIVES: Extensive tracheal airway defects represent a clinical dilemma. Although resection and reanastomosis and staged tracheoplasty may prove beneficial in some cases, recurrent or extensive circumferential stenosis remains a reconstructive challenge. We report the use of the allograft tracheoplasty technique for the reconstruction of recurrent, extensive defects of the trachea and cricoid. METHODS: Nine consecutive patients with recurrent tracheal stenosis were treated with the two-stage allograft tracheoplasty technique. A retrospective review was performed to evaluate for prior surgery, length of stenosis, surgical technique, and outcome. All 9 patients underwent multiple surgical procedures for acquired tracheal stenosis (average, 3.4 procedures) before undergoing the allograft tracheoplasty technique. Before surgery, all patients were tracheotomy-dependent. RESULTS: The patients were assessed 8 to 39 months after allograft tracheoplasty. The primary airway disorders included postintubation stenosis (n = 6), surgical resection for malignancy (n = 1), and idiopathic stenosis (n = 2). Three defects involved 30% to 60% of the cricoid cartilage, and 4 defects were complete circumferential tracheal defects. Five patients underwent an island deltopectoral flap for closure of the tracheoplasty site. One patient had a superficial wound infection at the cartilage recipient site, and 1 patient had a hematoma at the deltopectoral flap donor site. All 9 patients were successfully decannulated without shortness of breath, stridor, or recurrent stenosis at the time of follow-up. CONCLUSIONS: Allograft tracheoplasty is a new technique for the reconstruction of recurrent tracheal stenosis. It appears to be reliable for extensive airway defects that are refractory to conventional tracheoplasty techniques.

Adult↗

PubMed2006

Endoscopic treatment of severe tracheal stenosis.

OBJECTIVES: Endoscopic treatment of subglottic and tracheal stenosis has traditionally been reserved for short-segment and web-like stenoses with normal cartilage. This retrospective case series review was undertaken to examine my experience with definitive endoscopic treatment for circumferential and complete tracheal stenosis with loss of cartilaginous support. METHODS: Patients who presented with tracheostomy dependence or dyspnea as a result of clinically significant tracheal stenosis over a 2-year period were treated endoscopically. Mitomycin C was applied after dilation in 19 patients. Three patients with complete stenosis and cartilage collapse underwent endoscopic placement of a silicone elastic stent, which was in place for less than 23 days. RESULTS: Twenty patients were treated for tracheal stenosis over a 2-year period. No surgical complications were observed after operation in the endoscopic treatment group. Three of 6 patients with complete stenoses and 8 of 10 patients with circumferential stenoses with cartilage involvement gained airways that remained patent. Nine patients' stenoses resolved after the initial treatment. Three patients (15%) eventually required tracheal resection. The follow-up periods ranged from 5 to 25 months. CONCLUSIONS: Although some limitations apply, severe and complete tracheal stenoses may be successfully treated endoscopically with the techniques described. Definitive endoscopic treatment may be considered before tracheal resection in select cases. Endoscopic treatment is associated with few complications, low morbidity, a short operative time, and a short length of hospitalization.

Adolescent↗

PubMedDate not supplied

[The surgical management of tracheal stenosis].

We analyzed 26 cases of tracheal stenosis treated (ET) surgically at the National Institute of Respiratory Diseases between March 1987 and June 1990. The surgical technique practiced was end-to-end anastomosis of the trachea (ATT). The most important cause of stenosis was oro-tracheal intubation (69.2 percent). Followed by tracheostomy, respiratory scleroma, thyroid carcinoma with tracheal invasion and neck trauma. We describe the treatment of the patients and discussed the results, which were satisfactory from the functional anatomical point of view in all patients except one who died of hepatic coma 2 weeks postoperatively. We conclude that end-to-end anastomosis of the trachea is the treatment of choice to tracheal stenosis.

Adolescent↗

PubMed1997

Nitinol alloy endotracheal stent for treatment of tracheal stenosis.

OBJECTIVE: To treat inoperable tracheal stenosis by using nitinol endotracheal stent and to solve some problems facing endotracheal stenting with other kinds of stents. METHODS: The stent was made of nitinol wire. It can be deformed to smaller size in iced water. With a self-made introducer, the stent was placed in the location of stenosis. After hot water was injected into the introducer, the stent resumed its original form and anchored there itself. RESULTS: Altogether, 5 patients with severe tracheal stenosis received this treatment. Dyspnea was relieved immediately after implantation of stents in all patients. Long-term follow-up also showed satisfactory results. CONCLUSION: Nitinol stent has some remarkable advantages as compared with other tracheal stents. It can be used as a new endoprosthesis in treating narrowed trachea.

Adult↗

PubMed1991

Acquired tracheal stenosis in infants and children.

Acquired tracheal stenosis in childhood is frequently difficult to manage because of poor healing, infection, and scarring. In a 10-year period, 62 patients (4 weeks to 14 years of age) were treated for acquired tracheal stenosis. The causes of stenosis were endotracheal intubation (44 patients), caustic aspiration (6 patients), recurrent infection (5 patients), bronchoscopic perforation (4 patients), and gastric aspiration (3 patients). The subglottic or upper trachea was involved in 47 patients, mid portion in 8, and distal or carinal area in 7. Fifty children underwent tracheostomy as part of the therapy, and 12 were managed without tracheostomy. Therapy was individualized, frequently sequentially, utilizing rigid or balloon dilatation (20 patients), bronchoscopic electrocoagulation resection (44 patients), steroid injection (48 patients), T tube stent (8 patients), resection with anastomosis (12 patients), cricoid split (3 patients), and rib cartilage graft (12 patients). Most patients required several techniques and repeated procedures to eventually achieve decannulation. Seven patients (11%) died of unrelated causes. Forty-four of 55 surviving patients (80%) are without tracheostomy, although 14 have required continued endotracheal treatment after tracheostomy removal (dilatation, endotracheal resection). This series demonstrates that acquired tracheal stenosis in childhood is a common, difficult problem, but manageable with the use of a variety of techniques. Resection and grafting procedures should be reserved for cases in which less complex modalities fail.

Adolescent↗

PubMed1995

[Clinical experiences with the insertion of Dumon-type endotracheal stent tube for the patients with tracheal stenosis due to advanced esophageal carcinoma].

To relieve tracheal stenosis due to esophageal carcinoma, we have inserted Dumon-type endotracheal stent tube to 2 patients with stenosis of the left main bronchus and a patient with tracheal stenosis. Severe dyspnea and stridor found in these patients was much improved in all three cases. After insertion of the stent tube to 2 patients with stenosis of the left main bronchus, radiation therapy with the dose of 65 Gy to main esophageal lesion was undergone, which resulted in the partial remission. These management allowed the patients to discharge. The last case with tracheal stenosis was due to recurrence of the esophageal carcinoma, which required additional insertion of the stent tube at the proximal site after initial insertion in a short period. We conclude that the quality of life and prognosis of patients with tracheal stenosis due to advanced esophageal carcinoma may be improved by the insertion of Dumon-type endotracheal stent tube.

Aged↗

PubMed1996

Effect of conventional mechanical ventilation and jet ventilation on airway pressure in dogs and plastic models with tracheal stenosis.

OBJECTIVE: To evaluate the effect of jet ventilation on tracheal stenosis in dogs and plastic models. DESIGN: Prospective, randomized trial in dogs, and multitrial tests in tracheal stenosis models. SETTING: Animal laboratory in a university setting. INTERVENTIONS: Tracheal stenosis was surgically created around the middle of the trachea. Conventional mechanical ventilation and jet ventilation were compared at the same value of Paco2 in dogs and at the same tidal volume in tracheal stenosis models. SUBJECTS: Twelve mongrel dogs and four types of plastic models with combinations of short or long stenosis and fluid or nonfluid stenosis. MEASUREMENTS AND MAIN RESULTS: Canine Studies. Mean peak peak airway pressure values at the distal and proximal portion of the stenosis, and the end-expiratory pressure at the distal portion of the stenosis, were significantly higher during conventional mechanical ventilation than during jet ventilation. The mean values of arterial pressure, pulmonary arterial pressure, central venous pressure, and cardiac output did not change significantly between conventional mechanical ventilation and jet ventilation, except for the pulmonary artery occlusion pressure valve. Plastic Mold Studies. peak airway pressure and end-expiratory airway pressure at the poststenotic trachea during jet ventilation with the model lung were significantly lower than during conventional mechanical ventilation. The difference in peak airway pressure, and end-expiratory airway pressure values between jet ventilation and conventional mechanical ventilation increased more in short stenosis and nonfluid stenosis. CONCLUSIONS: The jet flow that struck the portion of the stenosed wall reversed direction, even during early expiration. Therefore, the expiration during jet ventilation was facilitated more by the reversed flow than by the expiration during conventional mechanical ventilation. This reversed flow may provide lower end-expiratory airway pressure at the poststenotic portion with jet ventilation than with conventional mechanical ventilation. We conclude that jet ventilation was a useful method of ventilation in cases with tracheal stenosis, especially nonfluid and short stenosis.

Animals↗

PubMedDate not supplied

Predictive factors of success or failure in the endoscopic management of laryngeal and tracheal stenosis.

Stenosis of the larynx and/or trachea presents perplexing problems. No one technique has proved totally satisfactory in the management of all varieties of stenosis. Recent reports have described the successful use of the CO2 laser in the endoscopic management of stenosis of the larynx and trachea. Failures of this technique need emphasis to assure appropriate selection of therapeutic method. Retrospectively, 49 cases of laryngeal stenosis, 6 cases of tracheal stenosis and 5 cases of combined laryngeal and tracheal stenosis were studied (total 60 patients) following treatment at the Boston University Affiliated Hospitals. Follow-up ranged from 1 to 8 years. Multiple procedures were required in 35 laryngeal patients. Of the laryngeal patients 39 were successfully managed (average number of procedures in successful cases 2.18). Of 11 tracheal patients with combined laryngeal and tracheal procedures, 3 were successfully managed (average number of procedures in successful cases 6). Failures in laryngeal stenosis included four patients in whom an adequate airway was not established though voice was present while maintaining tracheostomies. Thirteen patients failing endoscopic management required open surgery with good result. Factors associated with poor result or failure include circumferential scarring with cicatricial contracture, scarring wider than 1 cm in vertical dimension, tracheomalacia and loss of cartilage, previous history of severe bacterial infection associated with tracheostomy, and posterior laryngeal inlet scarring with arytenoid fixation. In these circumstances, multiple procedures, more extensive alternative open surgical techniques, or maintenance of tracheostomy were necessary. In successful cases only three or fewer procedures on average were required. The factors associated with failure or success of endoscopic methods in the management of laryngotracheal stenosis, including use of the CO2 laser and soft Silastic stents, are analyzed.

Adolescent↗

PubMedDate not supplied

Correction of segmental tracheal stenosis in children.

Segmental tracheal stenosis in children may be either acquired or congenital in nature. Acquired injuries usually involve a previous tracheostomy site or an area just superior to the carina. Congenital stenosis may occur in any location and often is associated with pulmonary agenesis. Surgical correction may be undertaken relatively safely in children of any age by segmental resection. We report three patients ranging in age from 4 weeks to 3 years who were corrected successfully. The use of cardiopulmonary bypass may be indicated, especially in young infants, to facilitate resection.

Child, Preschool↗

PubMed1997

Experience in tracheobronchial reconstruction with a costal cartilage graft for congenital tracheal stenosis.

Although successful surgical management of congenital tracheal stenosis has been reported, it is still controversial as to the best operative procedure. Eleven infants with congenital tracheal stenosis were evaluated to confirm the efficacy of tracheobronchial reconstruction with costal cartilage graft. Symptoms ranged from recurrent respiratory infection to severe respiratory failure. All infants had other congenital anomalies in addition to tracheal stenosis. Notably, five infants had pulmonary artery sling and four infants had patent ductus arteriosus. Definitive diagnosis was made by bronchoscopy, results of which showed complete tracheal rings in all patients with severely compromised tracheobronchial lumens. Five infants had elongated stenosis involving nearly the whole length of the trachea, and five infants had segmental stenosis involving nearly one half the length of the trachea. One infant had bilateral stenosis of the main bronchi. Early experience included two deaths from problems related to the repair. The involvement of the carina and the distal portion of the trachea was associated with increased complications and a higher mortality rate. Currently, our preferred technique facilitated by extracorporeal membrane oxygenation (ECMO) includes carinal reconstruction with a thin-wall intraluminal stent. Bronchoscopy is essential for accurate intraoperative incision of the trachea, post-operative airway management for several weeks, and removal of the intraluminal stent.

Bronchi↗