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Pediatric Surgery International

, Volume 35, Issue 5, pp 565–568 | Cite as

Repair of type IV laryngotracheoesophageal cleft (LTEC) on ECMO

  • Insu Kawahara
  • Kosaku MaedaEmail author
  • Yoshitomo Samejima
  • Keisuke Kajihara
  • Kotaro Uemura
  • Kozo Nomura
  • Kaori Isono
  • Keiichi Morita
  • Hiroaki Fukuzawa
  • Makoto Nakao
  • Akiko Yokoi
Original Article

Abstract

Purpose

A type IV laryngotracheoesophageal cleft (LTEC) is a very rare congenital malformation. Type IV LTEC that extends to the carina have poor prognosis and are difficult to manage. We present our experience with surgical repair in such a case using extracorporeal membranous oxygenation (ECMO).

Methods

A male infant, who was diagnosed with Goldenhar syndrome, showed severe dyspnea and dysphagia. Laryngoscopy indicated the presence of LTEC. The patient was transferred to our institute for radical operation 26 days after birth. Prior to surgery, a balloon catheter was inserted in the cardiac region of stomach through the lower esophagus to block air leakage, to maintain positive pressure ventilation. We also performed observations with a rigid bronchoscope to assess extent of the cleft, and diagnosed the patient with type IV LTEC. After bronchoscopy, we could intubate the tracheal tube just above the carina. Under ECMO, repair of the cleft was performed by an anterior approach via median sternotomy.

Results

The patient was intubated via nasotracheal tube and paralysis was maintained for 2 weeks, using a muscle relaxant for the first 3 days. Two weeks after surgery, rigid bronchoscopy showed that the repair had been completed, and the tracheal tube was successfully extubated without tracheotomy.

Conclusions

Although insertion of a balloon catheter is a very simple method, it can separate the respiratory and digestive tracts. This method allowed for positive pressure ventilation and prevented displacement of the endotracheal tube until ECMO was established. As a result, we safely performed the operation and the post-operative course was excellent.

Keywords

Laryngotracheoesophageal cleft Dyspnea Dysphagia Rigid bronchoscopy Extracorporeal membranous oxygenation 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent for publication was obtained from the guardians of the patient in this case report, as potentially identifying information may be included in this article.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Insu Kawahara
    • 1
  • Kosaku Maeda
    • 1
    Email author
  • Yoshitomo Samejima
    • 1
  • Keisuke Kajihara
    • 1
  • Kotaro Uemura
    • 1
  • Kozo Nomura
    • 1
  • Kaori Isono
    • 1
  • Keiichi Morita
    • 1
  • Hiroaki Fukuzawa
    • 1
  • Makoto Nakao
    • 1
  • Akiko Yokoi
    • 1
  1. 1.Department of Pediatric SurgeryKobe Children’s HospitalKobeJapan

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