Surgical treatment of tracheal or bronchial stenosis related to severe congenital heart disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Xiangyang , LIU Hao , ZHU Jie , GUAN Xinqiang , WEI Yalin , ZHANG Yanchun , CHEN Wensheng , LI Caie , LEI Lei , ZHANG Yanhua ,  ZHAO Qiming

Department of Cardiac Surgery, the Second Hospital of Lanzhou University, Lanzhou, 730030, P.R.China;

Corresponding author：

ZHAO Qiming, Email: clint0251@163.com

Keywords：

Congenital cardiac defects; pulmonary arterial hypertension; tracheal/bronchial stenosis; surgery

DOI：

10.7507/1007-4848.201607015

Video：

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Objective To explore a new surgical treatment of patients with severe congenital heart disease associated with tracheal or bronchial stenosis. Methods We retrospectively analyzed clinical data of 32 patients with severe pulmonary blood increased congenital heart disease complicated with tracheal or bronchial stenosis in our hospital between June 2010 and June 2014. There were 18 males and 13 females with an average age of 14.6±4.0 months and a weight of 8.8±3.0 kg. Results Average hospital stay was 12 days. Duration of intraoperative cardiopulmonary bypass was 65.0±21.0 min. Duration of aortic interruption was 42.0±16.0 min. Duration of postoperative ventilator was 25.0±18.0 h. ICU retention time was 4.0±1.8 d. All patients were survived. On the 9th day after surgery, the X-ray chest film revealed that the cardio-thoracic ratio was reduced compared with pre-operation but no statistical significance (P>0.05). Left ventricular end-diastolic dimension (LVEDD) was decreased (P<0.05). Pulmonary artery pressure was lower (P<0.01). The velocity of bloodstream in pulmonary artery was approximately normal. The computed tomography angiography (CTA) on the 9th day after surgery revealed that diameter of pulmonary artery in all patients reduced compared with that of pre-operation (P<0.01). Tracheal diameter of 28 patients returned to normal level and 3 patients had residual mild tracheal stenosis. All preoperative atelectasis recovered to normal level. All patients recovered completely. When the patients were followed up for 6 months to 4 years, the patients grew healthily and no abnormity occurred. Conclusion For the patients with tracheal or bronchial stenosis related to severe congenital heart disease,it is necessary to adopt surgical procedure to relieve the pressure of trachea or bronchus.The bronchial decompression surgery is a perfect and effective method for the patients with tracheal or bronchial stenosis related to severe congenital heart disease.

Citation： WU Xiangyang, LIU Hao, ZHU Jie, GUAN Xinqiang, WEI Yalin, ZHANG Yanchun, CHEN Wensheng, LI Caie, LEI Lei, ZHANG Yanhua, ZHAO Qiming. Surgical treatment of tracheal or bronchial stenosis related to severe congenital heart disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(3): 196-200. doi: 10.7507/1007-4848.201607015 Copy

1.	Yamaguchi M, Oshima Y, Hosokawa Y, et al. Concomitant repair of congenital tracheal stenosis and complex cardiac anomaly in small children. J Thorac Cardiovasc Surg, 1990, 100(2): 181-187.
2.	葛均波, 徐永健, 主编. 内科学. 第 8 版. 北京. 人民卫生出版社, 2013.
3.	Kim ES, Yoon JY, Kim TK, et al. Severe airway obstruction in an infant with congenital tracheal stenosis and congenital heart disease-A case report. Korean J Anesthesiol, 2012, 62(3): 285-288.
4.	Freitag L, Ernst A, Unger M, et al. A proposed classification system of central airway stenosis. Eur Respir J, 2007, 30(1): 7-12.
5.	杜舟, 朱丽敏, 刘金龙, 等. 先天性气管狭窄气道形态评估和早期预后的相关性. 中华胸心血管外科杂志, 2015, 31(8): 494-498.
6.	Herrera P, Caldarone C, Forte V, et al. The current state of congenital tracheal stenosis. Pediatr Surg Int, 2007, 23(11): 1033-1044.
7.	陈金兰, 杨一峰, 刘锋, 等. 先天性心脏病合并气道异常的围术期处理. 中国胸心血管外科临床杂志, 2010, 17(6): 509-511.
8.	Kaneko Y, Achiwa I. Congenital heart surgery in patients with coexisting congenital anomalies of respiratory or digestive system. Kyobu Geka, 2012, 65(8): 665-668.
9.	Xu ZW, Li WH. One stage surgical correction of congenital cardiac disease and congenital tracheal stenosis in infants and children. J Card Surg, 2009, 24(5): 558-560.
10.	Suh YJ, Kim GB, Kwon BS, et al. Clinical course of vascular rings and risk factors associated with mortality. Korean Circ J, 2012, 42(4): 252-258.
11.	Wijeweera O, Ng SB. Retrospective review of tracheoplasty for congenital tracheal stenosis. Singap Med J, 2011, 52(10): 726-729.
12.	Xue B, Liang B, Wang S, et al. One-stage surgical correction of congenital tracheal stenosis complicated with congenital heart disease in infants and young children. J Card Surg, 2015, 30(1): 97-103.
13.	Lai SH, Liao SL, Wong KS. Cardiovascular-associated tracheobronchial obstruction in children. Cardiol Young, 2013, 23(2): 233-238.
14.	曾双林, 李亚军, 黄霆, 等. 先天性心脏病和支气管发育异常相关性的探讨. 中国当代儿科杂志, 2011, 13(11): 893-895.
15.	Rimell FL, Stool SE. Diagnosis and management of pediatric tracheal stenosis. Otolaryngol Clin North Am, 1995, 28(4): 809-827.
16.	Ho AS, Koltai PJ. Pediatric tracheal stenosis. Otolaryngol Clin North Am, 2008, 41(5): 999-1021.
17.	Kussman BD, Geva T, Mcgowan FX. Cardiovascular causes of airway compression. Paediatr Anaesth, 2004, 14(1): 60-74.
18.	Nomura N, Asano M, Mizuno A, et al. Translocation of dilated pulmonary artery for relief of bronchial compression associated with ventricular septal defect. Eur J Cardiothorac Surg, 2007, 32(6): 937-939.

1. Yamaguchi M, Oshima Y, Hosokawa Y, et al. Concomitant repair of congenital tracheal stenosis and complex cardiac anomaly in small children. J Thorac Cardiovasc Surg, 1990, 100(2): 181-187.
2. 葛均波, 徐永健, 主编. 内科学. 第 8 版. 北京. 人民卫生出版社, 2013.
3. Kim ES, Yoon JY, Kim TK, et al. Severe airway obstruction in an infant with congenital tracheal stenosis and congenital heart disease-A case report. Korean J Anesthesiol, 2012, 62(3): 285-288.
4. Freitag L, Ernst A, Unger M, et al. A proposed classification system of central airway stenosis. Eur Respir J, 2007, 30(1): 7-12.
5. 杜舟, 朱丽敏, 刘金龙, 等. 先天性气管狭窄气道形态评估和早期预后的相关性. 中华胸心血管外科杂志, 2015, 31(8): 494-498.
6. Herrera P, Caldarone C, Forte V, et al. The current state of congenital tracheal stenosis. Pediatr Surg Int, 2007, 23(11): 1033-1044.
7. 陈金兰, 杨一峰, 刘锋, 等. 先天性心脏病合并气道异常的围术期处理. 中国胸心血管外科临床杂志, 2010, 17(6): 509-511.
8. Kaneko Y, Achiwa I. Congenital heart surgery in patients with coexisting congenital anomalies of respiratory or digestive system. Kyobu Geka, 2012, 65(8): 665-668.
9. Xu ZW, Li WH. One stage surgical correction of congenital cardiac disease and congenital tracheal stenosis in infants and children. J Card Surg, 2009, 24(5): 558-560.
10. Suh YJ, Kim GB, Kwon BS, et al. Clinical course of vascular rings and risk factors associated with mortality. Korean Circ J, 2012, 42(4): 252-258.
11. Wijeweera O, Ng SB. Retrospective review of tracheoplasty for congenital tracheal stenosis. Singap Med J, 2011, 52(10): 726-729.
12. Xue B, Liang B, Wang S, et al. One-stage surgical correction of congenital tracheal stenosis complicated with congenital heart disease in infants and young children. J Card Surg, 2015, 30(1): 97-103.
13. Lai SH, Liao SL, Wong KS. Cardiovascular-associated tracheobronchial obstruction in children. Cardiol Young, 2013, 23(2): 233-238.
14. 曾双林, 李亚军, 黄霆, 等. 先天性心脏病和支气管发育异常相关性的探讨. 中国当代儿科杂志, 2011, 13(11): 893-895.
15. Rimell FL, Stool SE. Diagnosis and management of pediatric tracheal stenosis. Otolaryngol Clin North Am, 1995, 28(4): 809-827.
16. Ho AS, Koltai PJ. Pediatric tracheal stenosis. Otolaryngol Clin North Am, 2008, 41(5): 999-1021.
17. Kussman BD, Geva T, Mcgowan FX. Cardiovascular causes of airway compression. Paediatr Anaesth, 2004, 14(1): 60-74.
18. Nomura N, Asano M, Mizuno A, et al. Translocation of dilated pulmonary artery for relief of bronchial compression associated with ventricular septal defect. Eur J Cardiothorac Surg, 2007, 32(6): 937-939.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment of tracheal or bronchial stenosis related to severe congenital heart disease

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