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PubMed1990

Concomitant repair of congenital tracheal stenosis and complex cardiac anomaly in small children.

Severe obstructive lesion of the trachea combined with complex congenital cardiac anomaly has generally been regarded as a fatal disease. Herein we report the successful concomitant repair of severe tracheal stenosis and complex cardiac anomaly with the use of cardiopulmonary bypass in two cases. The first patient was a 5-year-old boy with tetralogy of Fallot associated with a localized intrathoracic tracheal stenosis caused by complete cartilaginous rings. Tracheal resection and end-to-end anastomosis combined with total correction of tetralogy of Fallot was performed with the aid of cardiopulmonary bypass. The second patient was a 5-month-old girl with a pulmonary artery sling, scimitar syndrome, and extensive tracheal stenosis. The patient underwent definitive correction of cardiac lesions and complete tracheal reconstruction with a cartilaginous graft with the aid of cardiopulmonary bypass. Utmost care was paid to avoid contamination during the operation. Both of the patients are doing well at present without any signs of complication, 2 years 5 months and 1 year 10 months after the operation, respectively. We advocate concomitant repair of both lesions, with cardiopulmonary bypass, in the surgical managements of infants and small children who have a difficult and otherwise fatal combination of complex congenital cardiac anomaly and severe intrathoracic tracheal stenosis.

Cardiopulmonary Bypass↗

PubMed1981

Superiorly based tracheostomal flap to counteract tracheal stenosis: experimental study.

A superiorly based tracheal flap raised from the anterior tracheal wall was rotated anteriorly and superiorly to be sutured to the subcutaneous tissues. A series of 16 tracheostomies were performed on mongrel dogs. The stenosing effects of conventionally performed operations were compared to those of the new method. Autopsy sections of the post-tracheostomy sites demonstrated a significant loss of anteroposterior diameter averaging 16.5% as compared to the original unoperated-on luminae. No signs of tracheal stenosis were found whenever the proposed new technique was employed. This technique seems applicable to patients in whom assisted ventilation is contemplated.

Animals↗

PubMed1991

Tracheoplasty for congenital long-segment intrathoracic tracheal stenosis.

Congenital long-segment intrathoracic tracheal stenosis (CTS) is a rare life-threatening obstruction in infancy and childhood. From July 1983 to March 1988 six infants aged 14 days to 14 months with CTS were identified. Symptoms ranged from recurrent stridor and wheezing to severe respiratory compromise and hypercarbia. Routine chest x-rays were not diagnostic. Definitive diagnosis was made by bronchoscopy, which showed complete tracheal rings in all patients with severely compromised tracheobronchial lumens. In three patients, pericardium was successfully used for anterior tracheoplasty with one early death due to fulminant sepsis in an infant with undiagnosed sickle cell disease. The other two died late, at 3 and 9 months from problems unrelated to the repair. In three patients a rib graft was used for repair; in one, tracheoplasty was required after earlier repair of tetralogy of Fallot. All are late survivors with no postoperative symptoms. After recognition of CTS, prompt surgery is warranted to avoid the late complications of tracheostomy for long-term ventilatory support. Rigid repair with rib cartilage is preferable to use of pericardium. Proper rib harvesting with intact perichondrium, intraoperative bronchoscopy, oxygenation by cardiopulmonary bypass, and meticulous graft alignment are necessary for successful postoperative outcome.

Bronchoscopy↗

PubMed2006

Tracheal stenosis: a flow dynamics study.

Patients referred for treatment of tracheal stenosis typically are asymptomatic until critical narrowing of the airway occurs, which then requires immediate intervention. To understand how tracheal stenosis affects local pressure drops and explore how a dramatic increase in pressure drop could possibly be detected at an early stage, a computational fluid dynamics (CFD) study was undertaken. We assessed flow patterns and pressure drops over tracheal stenoses artificially inserted into a realistic three-dimensional upper airway model derived from multislice computed tomography images obtained in healthy men. Solving the Navier-Stokes equations (with a Yang-shih k-epsilon turbulence model) for different degrees of tracheal constriction located approximately one tracheal diameter below the glottis, the simulated pressure drop over the stenosis (DeltaP) was seen to dramatically increase only when well over 70% of the tracheal lumen was obliterated. At 30 l/min, DeltaP increased from 7 Pa for a 50% stenosis to, respectively, 46 and 235 Pa for 80% and 90% stenosis. The pressure-flow relationship in the entire upper airway model (between mouth and end of trachea) in the flow range 0-60 l/min showed a power law relationship with best-fit flow exponent of 1.77 in the absence of stenosis. The exponent became 1.92 and 2.00 in the case of 60% and 85% constriction, respectively. The present simulations confirm that the overall pressure drop at rest is only affected in case of severe constriction, and the simulated flow dependence of pressure drop suggests a means of detecting stenosis at a precritical stage.

Humans↗

PubMed1976

Surgical considerations in tracheal resection for tracheal stenosis.

Five patients were succesfully operated upon for tracheal stricture following prolonged assisted ventilation with a cuffed tracheal tube. The operative exposures and techniques to be recommended with relation to site and extent of tracheal stenosis are discussed. Most tracheal resections can be carried out through a low cervical incision. Lesions of the lower part of the trachea (5 cm or less from the carina) are best approached through a right posterolateral thoracotomy incision. A stenosed tracheal segment of 4 cm or less can be resected easily by both routes without undue tension on the anastomotic line. The use of interrupted Prolene sutures is proposed for the tracheal anastomosis, because it produces much less tissue reaction than chromic catgut.

Adolescent↗

PubMed1990

Management of congenital tracheal stenosis in infants.

Until recently congenital tracheal stenosis presenting in infants was considered to be almost invariably lethal. With improved diagnostic, anaesthetic and surgical techniques virtually all cases are potentially curable. Prompt recognition and early surgical intervention, combined with skilled perioperative management, will result in a more favourable outcome.

Anesthesia, General↗

PubMed2000

Surgical management of idiopathic subglottic tracheal stenosis.

A case of idiopathic subglottic tracheal stenosis in a 50-year-old female is presented. A procedure of single-stage resection of the lesion and end-to-end anastomosis was performed with excellent results 1 year after the operation. The clinical, paraclinical, diagnostic, therapeutic and histopathological aspects of this rare pathologic condition are discussed and the literature on this topic is reviewed.

Female↗

PubMed1994

Endoscopic laser surgery for subglottic and tracheal stenosis.

Seventeen patients with subglottic and tracheal stenosis were treated with laser surgery. Six patients had airway stenosis caused by malignant tumors. Out of 16 patients who required emergency endolaryngeal laser surgery, satisfactory results were achieved in 12, obtaining a sufficient lumen for ventilation. Five cases with airway tumors underwent laser surgery to increase the airway lumen, however, only one patient showed excellent results, with a sufficient airway lumen not being obtained in the others. Airway obstructions due to tumor can be treated satisfactorily by laser surgery, though long-term postoperative follow-up confirmed recurrence of tumor in some cases, which is a problem that must be overcome in the future.

Head and Neck Neoplasms↗

PubMedDate not supplied

Congenital tracheal stenosis with associated cardiopulmonary anomalies: report of two cases with a review of the literature.

We present two infants with congenital tracheal stenosis with complete tracheal rings. Both had associated congenital anomalies. The first case showed cardiac malformations, and the second case had agenesis of the right lung. We review the literature, in particular with reference to tracheal stenosis and pulmonary agenesis. We also propose that the constellation of anomalies may result from defects in the cervical mesenchyme and, as such, may represent one end of a spectrum of cervical mesenchymal field defects.

Coronary Vessel Anomalies↗

PubMed1991

Congenital tracheal stenosis with unilateral pulmonary agenesis.

Cogenital tracheal stenosis with unilateral pulmonary agenesis is a rate and frequent fetal combination. In an 8-year period, 5 infants (ages 2 to 6 months) with these anomalies were treated. The presenting signs and symptoms consisted of wheezing, stridor, and tachypnea and included frank respiratory failure requiring emergency therapy in several patients. The operative repair consisted of segmental resection and anastomosis in one patient, and rib-cartilage tracheoplasty in the other four. Two infants died, one of cerebral hypoxia, and the other of aortotracheal fistula. Long-term follow-up in the three survivors is satisfactory.

Abnormalities, Multiple↗

PubMed2005

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

BACKGROUND: Congenital tracheal stenosis (CTS) may present as a life-threatening condition often requiring urgent surgical correction. We report our recent experience of 13 consecutive patients with CTS over the past 18 months. METHOD: Retrospective analysis of all patients with CTS admitted to our institution from January 2003 to June 2004. RESULTS: Five of 13 patients (6 boys and 7 girls) were premature at birth. Mean age at repair was 3.8 months (range, 7 days to 9 months). Ten presented with cardiac arrests or "near-death" spells, 4 with copresenting pulmonary infection. Nine patients were local and 4 were national. Surgical repairs included slide tracheoplasty (n = 5), cartilage patch tracheoplasty (n = 4), patch-and-slide tracheoplasty (n = 1), and balloon dilatation (n = 1). Preoperative computed tomographic imaging invariably underestimated the severity of pathology. Two patients with minimal symptoms were treated nonoperatively. Two patients required additional endobronchial stents for bronchomalacia. Cardiopulmonary bypass was used in 8 patients. There were 3 deaths, including 2 planned withdrawal of treatment. Two patients remained in hospital. The remaining patients were discharged from our hospital. CONCLUSIONS: Presentation of CTS can be precipitated by respiratory infection. Preoperative imaging often underestimates the caliber and length of pathology. The treatment options for patients with CTS including observation should be individualized.

Abnormalities, Multiple↗

PubMed1987

Nd-YAG laser surgery for severe tracheal stenosis physiologically and clinically masked by severe diffuse obstructive pulmonary disease.

Nd-YAG laser surgery was performed on six patients with tracheal stenosis complicating severe diffuse intrathoracic airways obstruction due to emphysema, chronic obstructive bronchitis and/or asthma. Tracheal stenosis was extrathoracic in four patients and both extrathoracic and intrathoracic in two patients. Results suggest that patients with severe chronic obstructive pulmonary disease and asthma have maximal expiratory and inspiratory flow volume patterns that may completely mask extrathoracic and intrathoracic tracheal stenosis. Following relief of tracheal obstruction with laser therapy, substantial improvement can occur both clinically and physiologically, as reflected by symptomatic relief and large increases in Vmax 50I and FVC.

Adult↗

PubMed2001

Surgical approach to funnel-shaped congenital tracheal stenosis.

PURPOSE: The aim of this study was to evaluate the results obtained by 2 different techniques of tracheoplasty in the treatment of long-segment, funnel-shaped congenital tracheal stenosis (CTS) in 2 tertiary paediatric hospitals. METHODS: The clinical records of patients with long segment congenital tracheal stenosis during the period January 1990 to June 1999 were reviewed retrospectively. Age, gender, symptoms, imaging (x-ray, computed tomography, magnetic resonance imaging, or bronchography), endoscopic findings, associated anomalies, treatment, intubation time, postoperative treatment, intensive care unit stay, complications, hospital stay, evolution, and follow-up time were analyzed. Short congenital tracheal stenosis treated by resection and end-to-end anastomosis are not included. Results are given as mean +/- SEM. RESULTS: Ten (7 boys, 4 girls) of 14 patients with CTS had a funnel-shaped CTS. Mean age at treatment was 9.7 +/- 4.8 months (range, 3 days to 4.7 years). All of the patients presented with CTS affecting the distal third of the trachea and 4 of them extension to 1 main stem bronchus. They were treated by 2 different types of tracheoplasty: anterior costal cartilage graft (ACGT, 6 patients) and slide tracheoplasty (ST, 4 patients). All the patients treated by ACGT failed: 4 died and 2 required further surgery for restenosis. Causes of death were acute respiratory failure during surgery (2 cases) and anastomotic dehiscence (2 cases). The patients treated with ST are asymptomatic and doing well. Mean postoperative intubation time of the ACGT group was 35 +/- 25 days (10 to 60 days), whereas in the ST group it was 14 +/- 12 days (0 to 51 days). Mean hospital stays were 292 +/- 271 days (21 to 563 days) and 24 +/- 13 days (7 to 63 days), respectively. Mean follow-up time is 28 +/- 14 months (3 to 94 months). CONCLUSIONS: Surgery of long-segment congenital tracheal stenosis has a high failure and complication rate with vital implications in prognosis. Treatment should be done in a multidisciplinary basis by a highly trained and motivated team. Slide tracheoplasty seems to be the better option, although further multicentre studies should be conducted.

Child, Preschool↗

PubMed1998

[Secondary obstructive sleep apnea syndrome in a patient with tracheal stenosis and bilateral recurrent paresis. Successful treatment with nasal continuous positive airway pressure therapy].

HISTORY AND ADMISSION FINDINGS: A 67-year-old woman complained of marked daytime sleepiness, as well as loud snoring and apnoeas during sleep. She was known to have had 3 thyroidectomies for goitre 41, 23 and 12 years ago, with known tracheal stenosis and recurrent nerve palsy for 11 years. Physical examination revealed marked stridor, hoarse voice and slightly enlarged and palpable recurrent right thyroid. INVESTIGATIONS: Polysomnography demonstrated a clearly elevated obstructive sleep apnoea activity (apnoea index: 34/h, apnoea-hypopnea index: 40/h, desaturation index: 31/h, minimal saturation: 63%). Selective tracheal imaging showed subglottic tracheal stenosis with an inspiratory luminal diameter of 4 mm and an expiratory luminal diameter of 8 mm. Lung function analysis revealed marked flattening of the flow-volume curve as sign of a functionally effective tracheal stenosis. These findings indicated a secondary obstructive sleep apnoea (OSA) due to tracheal stenosis and bilateral recurrent nerve palsy. The patient declined further studies, such as bronchoscopy. TREATMENT AND COURSE: As the patient did not want any surgical treatment, nasal continuous positive airway pressure therapy (CPAP) was instituted as a trial. No apnoea occurred at a pressure of 12 mm H2O and this was well tolerated. She has now continued CPAP at home for 12 months and her vigilance was markedly improved. CONCLUSIONS: Tracheal stenosis or recurrent nerve palsy is a rare cause of OSA which can be effectively treated by nasal CPAP.

Aged↗

PubMed2003

[Resection of tracheal stenosis with end to end anastomosis].

The aim of the study was evaluation of early results of tracheal resection with end to end anastomosis. Tracheal resection was performed in 5 patients with tracheal stenosis resulting from prolonged intubation. Three patients were admitted without tracheostomy, in two patients tracheostomy was performed in another hospital. Diagnostic tracheoscopy was performed in all the patients and the tracheal stenosis was found in a distance of 2.5-4 cm from the vocal cords. The diameter of stenosis was 1-4 mm, and the length of stenosis was as long as 3-5 cartilages of trachea. Three cartilages were resected in one patient, 4 cartilages in two patients and 5 cartilages in two patients. End to end anastomosis was performed using absorbable sutures (Vicryl 2-0). The intubation tube was removed just after the surgery. Four patients had no complication after the operation and one patient had temporary subcutaneous emphysema in the neck. For 4-11 months follow up after operation all the patients have had good breathing. Tracheal resection with end to end anastomosis is effective method of treatment of tracheal stenosis.

Adult↗

PubMed2005

Tracheal stenosis aftertracheostomy or intubation: review with special regard to cause and management.

To investigate the management outcomes of patients who developed tracheal stenosis after tracheostomy or intubation, we reviewed the courses of 45 patients who had experienced tracheal stenosis at a single institution, over 19 years from February 1985 through January 2004. There were 38 tracheal and 7 infraglottic stenoses. Twenty-nine stenoses were associated with the stoma, 12 with the cuff, and 2 with the endotracheal tube resulting in infraglottic lesions; the remaining 2 were double stenoses. Eleven patients were treated by bronchoscopic surgery, and 34 patients were treated by tracheal or laryngotracheal resection. The overall success rate was 93%. The complication rate was 18%. A 2nd operation was required in 3 patients, and 1 of the 3 died of sepsis. Our management strategy of treating tracheal stenosis with resection and end-to-end anastomosis has been associated with good outcomes. Management of infraglottic stenosis is difficult, particularly when there is a large laryngeal defect or when there have been previous surgical attempts at the same site.

Adult↗

PubMed2000

Incidence of tracheal stenosis and other late complications after percutaneous tracheostomy.

OBJECTIVE: To determine the incidence of tracheal stenosis, voice and breathing changes, and stomal complications after percutaneous dilatational tracheostomy (PDT). METHODS: From December 1992 through June 1999, 420 critically ill patients underwent 422 PDTs. There were 340 (81%) long-term survivors, 100 (29%) of whom were interviewed and offered further evaluation by fiberoptic laryngotracheoscopy (FOL) and tracheal computed tomography (CT). Tracheal stenosis was defined as more than 10% tracheal narrowing on transaxial sections or coronal and sagittal reconstruction views. Forty-eight patients agreed to CT evaluation; 38 patients also underwent FOL. CT and FOL evaluations occurred at 30 +/- 25 (mean +/- standard deviation) months after PDT. RESULTS: Twenty-seven (27%) patients reported voice changes and 2 (2%) reported persistent severe hoarseness. Vocal cord abnormalities occurred in 4/38 (11%) patients, laryngeal granuloma in 1 (3%) patient, focal tracheal mucosal erythema in 2 (5%) patients, and severe tracheomalacia/stenosis in 1 (2.6%) patient. CT identified mild (11-25%) stenosis in 10 (21%) asymptomatic patients, moderate (26-50%) stenosis in 4 (8.3%) patients, 2 who were symptomatic, and severe (>50%) stenosis in 1 (2%) symptomatic patient. Ten patients (10%) reported persistent respiratory problems after tracheal decannulation, but only four agreed to be studied. Two patients had moderate stenosis, and one had severe stenosis. One patient's CT scan was normal. No long-term stomal complications were identified or reported. CONCLUSIONS: Subjective voice changes and tracheal abnormalities are common after endotracheal intubation followed by PDT. Long-term follow-up of critically ill patients identified a 31% rate of more than 10% tracheal stenosis after PDT. Symptomatic stenosis manifested by subjective respiratory symptoms after decannulation was found in 3 of 48 (6%) patients.

Adolescent↗

PubMed1995

Congenital tracheal stenosis: report of six cases.

We experienced six cases of congenital tracheal stenosis during a 3 years' period from October 1991 to September 1994 in Chang Gung Children's Hospital, Taiwan. The presenting symptoms of congenital tracheal stenosis varied from acute obstructive upper respiratory episodes in young childhood, stridor and wheezing since birth, recurrent bronchiolitis, difficult to intubate with endotracheal tube. Although bronchoscopy was diagnostic, but further imaging studies without anesthesia were equivocal. In spite of pericardial patch-tracheoplasties, the two cases undergoing surgery expired. During follow-ups, the remaining four patients suffered from persisting noisy respiration by conservative management.

Bronchoscopy↗