Advertisement

Pitfalls in the management of congenital tracheal stenosis: is conservative management feasible?

  • Yoshiko Usui
  • Shigeru Ono
  • Katsuhisa Baba
  • Yuki Tsuji
Original Article

Abstract

Purpose

Congenital tracheal stenosis (CTS) is rare and challenging. Complete tracheal rings cause a wide spectrum of airway-obstructing lesions and varying degrees of respiratory distress. Although surgical reconstruction is the primary option for symptomatic CTS, sometimes an appropriate management strategy may be difficult due to other anomalies. We aimed to identify pitfalls in the management of CTS.

Methods

We retrospectively reviewed the records of patients with CTS during the last 10 years in our institution.

Results

Sixteen pediatric patients were diagnosed with CTS. Of the 16 patients, 12 (75.0%) had cardiovascular anomalies including seven left pulmonary artery sling. Six patients with dyspnoea caused by CTS and three patients with difficult intubations due to CTS underwent tracheoplasty. Four patients underwent only cardiovascular surgery without tracheoplasty. Three asymptomatic patients were followed up without undergoing any surgical procedure. We repeatedly discussed management of four patients with especially complex pathophysiology at multidisciplinary meetings. Right ventricular outflow tract obstruction, tracheobronchial malacia, increased pulmonary blood flow, and pulmonary aspiration due to gastroesophageal reflux presumably accounted for their severe respiratory distress, and we forewent their tracheal reconstruction.

Conclusion

The management of CTS should be individualized, and conservative management is a feasible option in selected cases.

Keywords

Congenital tracheal stenosis Cardiovascular anomaly Balloon tracheoplasty Conservative management 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethics committee of Jichi Medical University and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

References

  1. 1.
    Cantrell JR, Guild HG (1964) Congenital stenosis of the trachea. Am J Surg 108:297–305CrossRefPubMedGoogle Scholar
  2. 2.
    Antón-Pacheco JL, Cano I, García A, Martínez A, Cuadros J, Berchi FJ (2003) Patterns of management of congenital tracheal stenosis. J Pediatr Surg 38:1452–1458CrossRefPubMedGoogle Scholar
  3. 3.
    Elliott M, Hartley BE, Wallis C, Roebuck D (2008) Slide tracheoplasty. Curr Opin Otolaryngol Head Neck Surg 16:75–82CrossRefPubMedGoogle Scholar
  4. 4.
    Airway Reconstruction Team (2005) Recent challenges in the management of congenital tracheal stenosis: an individualized approach. J Pediatr Surg 40:774–780CrossRefGoogle Scholar
  5. 5.
    Kwak JG, Kim WH, Min J, Lee C, Jang W, Lee CH (2013) Is tracheoplasty necessary for all patients with pulmonary artery sling and tracheal stenosis? Pediatr Cardiol 34:498–503CrossRefPubMedGoogle Scholar
  6. 6.
    Lee EY, Restrepo R, Dillman JR, Ridge CA, Hammer MR, Boiselle PM (2012) Imaging evaluation of pediatric trachea and bronchi: systematic review and updates. Semin Roentgenol 47:182–196CrossRefPubMedGoogle Scholar
  7. 7.
    Ono S, Maeda K, Baba K, Usui Y, Tsuji Y, Kawahara I, Fukuta A, Sekine S (2014) Balloon tracheoplasty as initial treatment for neonates with symptomatic congenital tracheal stenosis. Pediatr Surg Int 30:957–960CrossRefPubMedGoogle Scholar
  8. 8.
    Fiore AC, Brown JW, Weber TR, Turrentine MW (2005) Surgical treatment of pulmonary artery sling and tracheal stenosis. Ann Thorac Surg 79:38–46CrossRefPubMedGoogle Scholar
  9. 9.
    Cheng W, Manson DE, Forte V, Ein SH, MacLusky I, Papsin BC, Hechter S, Kim PC (2006) The role of conservative management in congenital tracheal stenosis: an evidence-based long-term follow-up study. J Pediatr Surg 41:1203–1207CrossRefPubMedGoogle Scholar
  10. 10.
    Loukanov T, Sebening C, Springer W, Ulmer H, Hagl S (2005) Simultaneous management of congenital tracheal stenosis and cardiac anomalies in infants. J Thorac Cardiovasc Surg 130:1537–1541CrossRefPubMedGoogle Scholar
  11. 11.
    Okamoto T, Nishijima E, Maruo A, Yokoi A, Takamizawa S, Satoh S, Oshima Y (2009) Congenital tracheal stenosis: the prognostic significance of associated cardiovascular anomalies and the optimal timing of surgical treatment. J Pediatr Surg 44:325–328CrossRefPubMedGoogle Scholar
  12. 12.
    Oshima Y, Yamaguchi M, Yoshimura N, Sato S, Muraji T, Nishijima E, Tsugawa C (2008) Management of pulmonary artery sling associated with tracheal stenosis. Ann Thorac Surg 86:1334–1338CrossRefPubMedGoogle Scholar
  13. 13.
    Loukanov TS, Sebening C, Springer W, Hagl S, Karck M, Gorenflo M (2009) The evolution of the pulmonary arterial sling syndrome, with particular reference to the need for reoperations because of untreated tracheal stenosis. Cardiol Young 19:446–450CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yoshiko Usui
    • 1
  • Shigeru Ono
    • 1
  • Katsuhisa Baba
    • 1
  • Yuki Tsuji
    • 1
  1. 1.Department of Pediatric Surgery, Jichi Children’s Medical Center TochigiJichi Medical UniversityShimotsukeJapan

Personalised recommendations