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PubMed1998

[Pulmonary artery sling with tracheal stenosis--primary repair in infancy].

Between 1984 and 1996 five infants underwent surgical repair of pulmonary artery sling associated with severe congenital tracheal stenosis. All infants had symptoms of severe respiratory distress and three of them required ventilator support preoperatively ages ranged from 2 to 11 months (mean age 6 months). Complete tracheal rings were present in all patients as an associated lesion and right upper lobe tracheal bronchus in 3 patients. The length of tracheal stenosis ranged from 18 to 45 mm (median 40 mm). Three had associated intracardiac anomalies (Scimitar syndrome (1), VSD (1), double-outlet right ventricle with VSD (1), double-outlet right ventricle with pulmonary hypertension (1)). Surgical intervention was carried out through a right thoracotomy (1) or median sternotomy (4). Cardiopulmonary bypass (CPB) was used in 3 patients and extracorporeal membrane oxgenator (ECMO). In 1. All infants had reimplantation of the left pulmonary artery into the main pulmonary artery left anterior to the trachea. Four patients underwent simultaneous tracheoplasty using costal cartilage grafts and one had complete resection of obstructed trachea between the right upper lobe tracheal bronchus and carina. The length of resected trachea was about 30% of the entire length of the trachea. Three infants underwent simultaneous intracardiac repair. There was no hospital death. All were weaned from ventilatory support and extubated on 1 to 16 months (mean 4, 5 months) postoperatively. AS an additional procedure, aortopexy, removal of granulation tissue or balloon dilatation of the trachea were carried out in one patient each following tracheoplasty using cartilage grafts. There was one late death at 1 year postoperatively. Three of 4 survivors are doing well with no stridor. We adonostridor. We adovocate 1) early aggressive primary repair of pulmonary artery sling with tracheal stenosis, 2) concomitant repair of tracheal lesion and intracardiac anomalies whenever possible, 3) application of CPB or ECMO to avoid cumbersome intubation technique, and 4) utmost effort to perform tracheal resection and end-to-end anastomosis.

Anastomosis, Surgical↗

PubMed1980

[Prevention and pretherapeutic evaluation of laryngo-tracheal stenosis in adult (author's transl)].

The prevention of laryngo-tracheal stenosis and their etiological factors are the subject of this study. The used material (tube, balloon,...) and the patient could be the principal reason of these etiology, either for intubation or tracheotomy. The pressure in the balloon and the tracheal mucosal puls are developed. The knowledgement of the principal etiologic factors in the constitution of laryngo-tracheal stenosis, make us able to prevent them with efficacity. Finaly, a preoperative evaluation by tomography and endoscopy is establiched.

Aged↗

PubMed2006

[Slide tracheoplasty in congenital tracheal stenosis].

OBJECTIVES: Slide Tracheoplasty has progressively become the gold standard in the management of long-segment tracheal stenosis in children and infants. However, in certain situations this operation might become difficult and others techniques might be preferred. MATERIAL AND METHODS: Five patients, 1 to 6 month old had surgery by our team, for complex tracheal stenosis between 2001 and 2005. Tracheal hypoplasia was considered complex because it was associated to either: an acquired critical stenosis, a cricoid stenosis, a bronchial stenosis, a tracheal bronchus or associated to oesophageal atresia and severe tracheomalacia. All of them have been treated by a modified slide tracheoplasty. RESULTS: The postoperative status required an average of 15 days in ICU, including 8 days of ventilation. Two patients had laryngeal nerve injury. Medium term follow up (27 months) demonstrated no need for re-intervention, good potential growth and normal child activity. CONCLUSIONS: Slide tracheoplasty can provide good results in certain cases of severe and complex tracheal hypoplasia in infants.

Age Factors↗

PubMed1999

[Anesthetic management using extracorporeal circulation of a patient with severe tracheal stenosis by thyroid cancer].

A 64-year-old male with tracheal stenosis by thyroid cancer was scheduled for the emergency management of airway maintenance and total thyroidectomy. Dyspnea and orthopnea appeared suddenly on the admission for operation. Cervical CT and bronchial fiberscope examination revealed the trachea oppressed at the frontal neck by thyroid tumor. The trachea diameter was nearly 5 mm at the narrowest part. Therefore it seemed to be of high risk of perform tracheal intubation and tracheostomy. Extracorporeal circulation was adopted for the respiratory management at anesthesia induction. At first, the femoral artery and vein were cannulated with local anesthesia for cardiopulmonary bypass (CPB). After confirming CPB pump working, intravenous anesthetic agents were infused. Thyroid tumor was partially resected and tracheostomy was done under CPB. After the tracheostomy, a spiral tracheal tube was inserted. Anesthesia was maintained with sevoflurane and managed with controlled ventilation. Thereafter operation and anesthesia were uneventful. After the operation, pleural bloody effusion was noticed. Blood in effusion seemed to be due to the heparinization in extracorporeal circulation. We conclude that anesthetic management with extracorporeal circulation is one of useful methods for managing severe tracheal stenosis.

Anesthesia, General↗

PubMed2002

Postintubation tracheal stenosis in an 11-year-old boy: a surgical and anaesthetic challenge.

We present a case of postintubation tracheal stenosis in an 11-year-old boy occurring after a relatively short period of intubation. He had been intubated and ventilated in a paediatric intensive care unit after a road traffic accident. Clinical symptoms manifested by oxygen desaturation and wheeziness, finally leading to deterioration of the level of consciousness, occurred a few hours after the first attempt at extubation after 48 h requiring reintubation. Endoscopic examination performed a few weeks later revealed a tracheal stenosis. Consequently, he underwent an initial period of conservative treatment consisting of balloon dilatation and intralesional injection of steroids, followed by a tracheal resection and reconstruction. The anaesthetic management of patients with tracheal stenosis presenting for laryngo-tracheobronchoscopy and balloon dilatation is discussed.

Anesthesia, General↗

PubMed2002

Costal cartilage tracheoplasty for congenital long-segment tracheal stenosis.

OBJECTIVES: To evaluate and report the outcome of costal cartilage tracheoplasty for the treatment of congenital long-segment tracheal stenosis. DESIGN: Retrospective chart review. SETTING: Academic tertiary care children's hospital. PATIENTS: Consecutive series of 10 patients who presented with congenital long-segment tracheal stenosis. INTERVENTION: All patients underwent costal cartilage tracheoplasty while receiving cardiopulmonary bypass. MEASUREMENTS: Age at repair, weight at repair, length of stenosis, minimal diameter of stenosis, postoperative days receiving ventilator support, postoperative days until discharge, postoperative bronchoscopies, postoperative complications, associated anomalies, survival rate, and current status. RESULTS: There were 8 males and 2 females with an average age at repair of 18 weeks. Average weight was 5.2 kg. Average length of stenosis was 3.2 cm, and average minimal diameter was 1.9 mm. Average postoperative days receiving ventilator support was 17 with a median of 9.5. Average postoperative days until discharge was 35.2 with a median of 17. Average postoperative bronchoscopies was 18 with a median of 4.5. There was a 40% major postoperative complication rate. Seven of the patients had associated anomalies. No patient died from an inadequate tracheal airway, though 2 patients ultimately died from other cardiopulmonary complications for a survival rate of 80%. Average time since surgery for survivors is 8.0 years. Two patients still require treatment. Seven of the original 10 patients are fully active without tracheostomy. CONCLUSION: We report one of the largest series of costal cartilage tracheoplasty for congenital long-segment tracheal stenosis and one that has met with a relatively high success rate.

Body Weight↗

PubMed1990

[A case of surgically treated newborn with congenital tracheal stenosis].

This is a case report of a newborn with congenital tracheal stenosis which was fortunately healed by surgery. A 2,650 g female infant was born at 39 wk gestation. She began having respiratory difficulty soon after birth. Prompt endotracheal intubation was attempted, but failed. She was transferred to our hospital under assisted ventilation. Chest roentgenogram and bronchoscopy demonstrated segmental narrowing of the trachea about 2 cm distal from the vocal cord. A surgical operation was performed because respiratory management would not be enough to save the infant. Through a transverse collar incision and an upper median sternotomy, a stenotic 7 mm length of the trachea was resected and anastomosed with 5-0 Dexon suture. Postoperative course was uneventful. Histologically, the stenotic segment consisted of hypoplasia of the tracheal cartilage and fibrosis of the membranous portion. Squamous metaplasia was also recognized. There was no other report of tracheal stenosis successfully operated during the period of newborn.

Female↗

PubMed1983

Continuous intravenous anaesthesia with Althesin for resection of tracheal stenosis.

The anaesthetic management of patients undergoing tracheal resection for tracheal stenosis and the advantage of the maintenance of spontaneous respiration without intubation of the distal tracheal segment is discussed. The case reports of two such patients using a continuous intravenous infusion of Althesin with maintenance of spontaneous respiration are presented. The technique expedited the surgical reanastomosis due to lack of instrumentation in the surgical field. While some mild respiratory depression as evidenced by carbon dioxide retention did occur, the technique is worthy of consideration for the procedure.

Adolescent↗

PubMed2004

[Endobronchial ultrasonography in postintubation tracheal stenosis].

INTRODUCTION: The correct evaluation of the tracheal wall's structure is necessary for the management of postintubation tracheal stenosis (PTS). Endobronchial ultrasonography (EBUS) is suitable for visualisation of layers of the tracheal wall and the assessment of cartilages' damage. AIM: The authors assessed the usefulness of EBUS in the anatomical characterization of PTS and in the decision making in its therapy. PATIENTS, METHODS: Between March 2002, and September 2003, 22 patients with PTS were examined by bronchoscopy together with EBUS. RESULTS: 13 patients had complex stenosis and from them destruction of tracheal cartilage was demonstrated in 5 patients. Of them bronchoscopic intervention resulted in only short term symptom free period in 3 patients. CONCLUSION: The destruction of tracheal cartilage detected by EBUS might be an indication for an early surgical intervention. According to author's results EBUS can be a useful method in evaluation of PTS.

Bronchi↗

PubMed2002

Tracheal stenosis after percutaneous dilational tracheotomy.

OBJECTIVE: In many critical care units percutaneous dilational tracheotomy (PDT) has become an alternative to open tracheotomy. Although significant tracheal stenosis after PDT has been reported, the exact incidence is unknown. We report our findings on endoscopic laryngotracheoscopy for a group of patients who had undergone PDT more than 6 months before their examination. STUDY DESIGN AND SETTING: We did a retrospective review of 108 trauma patients who underwent PDT at least 6 months before enrollment in the study. Twenty-eight patients were either deceased or ineligible. Participation requests were mailed to the last recorded address of 80 patients. Thirty-four of those patients were contacted by phone, and 14 indicated their willingness to participate. Only 10 patients were able to make it to the clinic for examination. After transorally anesthetizing the hypopharynx and larynx with 4% lidocaine, each patient underwent flexible laryngotracheoscopy. Findings were categorized as normal or tracheal stenosis (<25%, 25% to 50%, or >50%). RESULTS: The tracheotomy site was virtually undetectable in 5 patients. In 4 patients, a scar was visible at the tracheotomy site, but there was no decrease in cross-sectional area. In 1 patient there was a 25% to 50% stenosis. All patients were completely asymptomatic with regard to airway and voice quality. CONCLUSION: One out of 10 patients in our series had a significant but asymptomatic stenosis after PDT. The risk of tracheal stenosis in PDT appears to be the same as that of open tracheotomy.

Adult↗

PubMed1997

Epidural anaesthesia for ureteral reimplantation in an infant with congenital tracheal stenosis.

PURPOSE: We report a case of an infant with severe congenital tracheal stenosis who underwent ureteral reimplantation using lumbar epidural anaesthesia combined with light general anaesthesia. CLINICAL FEATURES: A six-month-old girl with symptomatic tracheal stenosis, demonstrated by computed tomography, was scheduled for ureteral reimplantation. She received continuous lumbar epidural anaesthesia with bupivacaine 0.25% through a 21 gauge catheter positioned at L3-4 interspace. Nitrous oxide/oxygen 50% and sevoflurane 1.5-2% were administered through a face mask and spontaneous breathing was preserved. Anaesthesia and surgery were uneventful. Postoperative epidural analgesia with bupivacaine 0.2% was excellent. The epidural catheter was withdrawn 48 hr postoperatively and she was discharged from the hospital five days later. CONCLUSION: Airway management is a major anaesthetic consideration in an infant with tracheal stenoses requiring abdominal surgery. We have demonstrated that regional anaesthesia combined with light general anaesthesia via face mask is an acceptable option, providing good analgesia during and after surgery. The technique preserves spontaneous ventilation and avoids tracheal manipulation.

Anesthesia, Epidural↗

PubMed1981

Tracheal stenosis after tracheostomy and after orotracheal cuffed intubation.

Tracheal stenosis occurred in 9 cases in a series of 812 tracheostomized patients, an incidence of 1.1%. Two additional stenoses had developed after orotracheal cuffed intubation. Two suprastomal, two stomal and seven infrastomal stenoses were confirmed. The stenosis was diagnosed within 10 weeks of extubation in 10 patients and 5 months after extubation in 1 case. The airway results were good after segmental resection and end to end anastomosis in 5 patients; satisfactory in 4 patients after various dilatation procedures and poor in 1 case after removal of granulation tissue. The mortality rate was 18%. One patient died on account of missed diagnosis and another of tracheo-innominate artery erosion with massive bleeding after tracheal resection. The present report indicates that the best airway results are achieved by segmental resection. Various dilatation procedures, however, produced satisfactory airway results and should be used as primary treatment when the stage of the stenosis makes resection inappropriate. When planning surgical treatment, X-ray examinations, tomography or tracheo-graphy are necessary for evaluation of the site and length of the stenosis. The stage of the stenosis can best be evaluated by tracheoscopy. The use of large, low-pressure thin-walled cuffs and avoidance of overinflation of the cuff are the most important measures for preventing the cuff-induced tracheal injury which may lead to tracheal stenosis.

Adolescent↗

PubMed1990

Management of tracheal stenosis in a dog.

A 28-month-old Cocker Spaniel was treated for tracheal laceration after bite-wound injury of the ventral area of the neck. Tracheal stenosis developed after surgical repair of the trachea. Bougienage failed to prevent recurrence of clinical signs of upper airway disease associated with tracheal stenosis. Resection of the stenotic lesion and tracheal anastomosis improved tracheal diameter and alleviated clinical signs of upper airway disease. A pulmonary function test (tidal breathing flow-volume loop) was used to assess upper airway function.

Animals↗

PubMed1980

Structure and function in tracheal stenosis.

The mechanism of airflow obstruction was investigated in 21 patients with tracheal stenosis using tantalung tracheograms and pulmonary function studies, including flow-volume (FV) loops. In 4 patients with severe obstructive pulmonary disease, FV loops failed to demonstrate radiographically visible tracheal stenosis. In 17 patients, both FV loops and tracheograms demonstrated central airway obstruction. In three of the 17 patients, the stenotic segment was a rigid lesion at the thoracic outlet with similar limitation of inspiratory and expiratory flow. In nine of the 17 patients, the lesion was extrathoracic (rigid in 6 patients and pliable in 3). The 3 pliable extrathoracic lesions produced marked limitation of inspiratory flow but normal expiratory flow. Three rigid extrathoracic lesions produced inspiratory flow that was more limited than expiratory flow, suggesting dynamic inspiratory compression of the normal extrathoracic trachea. The one rigid intrathoracic lesion caused expiratory flow limitation greater than inspiratory flow limitation, suggesting dynamic compression of the intrathoracic trachea on expiration. The position of the obstructing lesion and dynamic compression of the normal, compliant trachea may be the major determinants of the difference in flow limitation between expiration and inspiration in some patients.

Adolescent↗

PubMed1996

Post intubation tracheal stenosis.

Although the etiology of post intubation tracheal stenosis has been well defined and methods for its prevention clarified, the lesions continue to occur and to be the most common indication for tracheal reconstruction. These lesions with specific characteristics at various levels--such as cuff and stomal--present with the signs and symptoms of airway obstruction. They are best handled in an emergency with systematic dilation. Under certain circumstances surgical repair is best deferred using repetitive dilations or intubation through an appropriately located stoma. Preferred management is surgical resection with primary reconstruction. Special techniques are necessary in cases in which larynx is also involved. With diagnostic precision and meticulous surgical technique, good or satisfactory results were obtained in nearly 94% of 503 surgically treated patients. Best results are obtained at an initial corrective operation performed by an experienced operator.

Dilatation↗

PubMed2002

Primary repair of pulmonary artery sling with double outlet right ventricle and distal tracheal stenosis.

The fate of patients with pulmonary artery sling depends on associated tracheal lesions. Distal tracheal stenosis involving the carina frequently results in lethal obstruction due to secretion or inflammatory edema. Further-more, associated complex cardiac anomalies with excessive pulmonary flow make the situation more complicated. We present a case of successful simultaneous one-stage repair of pulmonary artery sling, double outlet right ventricle and distal tracheal obstruction. Pulmonary artery sling was relieved by relocation of the left pulmonary artery (left pulmonary artery to main pulmonary artery) and a tracheoplasty (resection and end-to-end anastomosis). We advocate early aggressive simultaneous repair of pulmonary artery sling with tracheal stenosis and concomitant repair of intracardiac anomalies whenever possible.

Abnormalities, Multiple↗

PubMed1975

[Reconstruction of tracheal stenosis at thoracic inlet level (author's transl)].

Complex operative cases of tracheal stenosis in the region of the thoracic inlet are described. The stenosed tracheas were additionally constricted by: a dislocated osteomyelitic clavicle, which was tethered by scar-tissue; an osteoma of the manubrium sterni; a goitre, which was fixed into the thoracic inlet by scar tissue of an early childhood tracheostomy; and a retrosternal goitre. In two further cases the reconstruction of a long tracheal stenosis at the thoracic inlet was complicated by an existing paraplegia.

Adult↗

PubMed1976

Emergency resection of distal tracheal stenosis. A case report.

A case of tracheal stenosis secondary to tracheostomy and respirator treatment is presented. The stenosis caused acute respiratory failure, which made immediate surgical intervention mandatory. It is stressed that usually the tracheal lumen is severely reduced when the stenosis causes alarming symptoms. Rational treatment, which must be instituted immediately, consists of resection of the stenotic area and end-to-end anastomosis.

Adolescent↗