Strategy Of Surgical Treatment To Congenital Heart Disease With Concomitant Congenital Tracheal Stenosis And Clinical Application Of Various Tracheoplasty Techniques.

Background and ObjectiveCongenital tracheal stenosis (CTS) in infants is an underdiagnosed, life-threatening respiratory anomaly. Associated congenital cardiac malformations are diagnosed often in this group of patients. They are represented mostly by ventricular septal defect (VSD) and atrial septal defect (ASD). Some of the more complicated congenital heart malformations can also accompany CTS:atrioventricular septal defects (AVSDs) and tetrelogy of Fallot (TOF). CTS often is associated with pulmonary vascular sling or bronchus suis, an anomalous right upper bronchus branching from the trachea. From a pathophysiologic point of view, it seems more reasonable to repair both the tracheal and cardiac pathology simultaneously. In this article, through to describe our experience, we analyzes and summarizes the effect of simultaneously surgical treatment to congenital heart disease(CHD) with concomitant congenital tracheal stenosis(CTS) and the different surgical alternatives of tracheal repair.Object and method3 infants underwent twe-stage surgical repair and 6 infants underwent simultaneous surgical repair of CTS and CHD. All patients were operated on through a median sternotomy and with cardiopulmonary bypass. After associated cardiac anomalies corrected, the tracheal repairs were performed,including tracheal resection with direct end-to-end anastomosis to localized tracheal stenosis in 2 patients, slide tracheoplasty to long-segment CTS in 3 patients, and cryopreserved aortic allograft (CCA) patch tracheoplasty to CTS with main bronchus involved in 1 patient.ResultsIn the twe-stage repair group,2 patients died of asphyxia and lung infection respectively. In the One-stage repair group, One patient performed with slide tracheoplasty died of granulation tissue on stoma 8 weeks postoperatively.5 patients were extubated between 6 hours and 2 days after operation. Postoperative CT examination showed adequate airway dimensions and patency in every case. The midterm results after a mean follow-up of 28 months (range,4?54 months) of the entire group demonstrate a stabile and complication-free clinical outcome.ConclusionWe advocate the strategy of simultaneously surgical treatment to CHD with concomitant CTS for infants. With cardiopulmonary bypass, intracardiac anomalies can be repaired, and tracheal reconstruction can be reassured.Different surgical alternatives of tracheal repair should be apt to the situs and extent of CTS. Management of congenital tracheal stenosis by mean of slide tracheoplasty or resection and reconstructions gives excellent short- and long-term results because the lesion is reconstructed with native tracheal tissue and is therefore immediately stable and lined with normal epithelium.If CTS involves a more long segment and/or main bronchus and a program of patch tracheoplasty has to be applied, CAA may be considered as a valuable tracheal substitute. Prolonged clinical application will be probably mandatory to authenticate the more long-time result of the procedure.