Skip to main content

Advertisement

SpringerLink
Log in

Successful surgical treatment of congenital tracheal stenosis combined with tracheal bronchus and left pulmonary artery sling: a 10-year single-institution experience

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

Radical surgery for congenital tracheal stenosis (CTS) is technically demanding. CTS combined with tracheal bronchus (TB) and pulmonary artery (PA) sling is a particularly challenging condition. We herein report our successfully modified surgical techniques for CTS combined with TB and PA sling.

Methods

Nine patients treated at our institution from July 2010 to December 2020 for CTS with TB and PA sling were enrolled. The patients’ characteristics, operative results, and clinical outcomes were reviewed and analyzed retrospectively.

Results

The mean age at the operation and body weight were 8.0 ± 4.4 months old and 6.5 ± 0.8 kg, respectively. The mean tracheal diameter and length of the stenotic lesion were 3.2 ± 1.0 mm (mean stenosis rate 46.2%) and 25.4 ± 4.9 mm, respectively. All cases were complicated with PA sling at bifurcation stenosis with tracheobronchomalacia. All patients underwent modified posterior-anterior slide tracheoplasty with an inverted Y-shaped incision at the bifurcation and repositioning of the PA. The mean postoperative intubation period was 25.0 ± 32.1 days. There were no major intraoperative or postoperative complications, including hypoxic-ischemic encephalopathy. The mean hospital stay was 92.2 ± 73.4 days. All patients were discharged home without tracheostomy or oxygen support.

Conclusion

Our slide tracheoplasty technique for CTS with TB and PA sling achieved excellent outcomes.

Level of evidence

Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Tsang V, Murday A, Gillbe C, Goldstraw P (1989) Slide tracheoplasty for congenital funnel-shaped tracheal stenosis. Ann Thorac Surg 48(5):632–635

    Article  CAS  Google Scholar 

  2. Grillo HC (1994) Slide tracheoplasty for long-segment congenital tracheal stenosis. Ann Thorac Surg 58(3):613–619 (discussion 619–621)

    Article  CAS  Google Scholar 

  3. Shimojima N, Shimotakahara A, Tomita H, Harumatsu T, Harada A, Maeda Y, Ito Y, Miyaguni K, Tsukizaki A, Abe K, Hashimoto M, Ishikawa M, Honda M, Kuroda T, Hirobe S (2022) Outcomes of slide tracheoplasty for congenital tracheal stenosis in 80 children: a 22-year single-center experience. J Pediatr Surg 57(7):1205–1209

    Article  Google Scholar 

  4. Lee KJ, Kamagata S, Hirobe S, Toma M, Furukawa T, Fukushima N, Inomata Y (2009) Aortopexy for tracheomalacia with dextrocardia, pulmonary artery sling, and congenital tracheal stenosis. Ann Thorac Surg 88(4):1345–1348

    Article  Google Scholar 

  5. Morita K, Yokoi A, Fukuzawa H, Hisamatsu C, Endo K, Okata Y, Tamaki A, Mishima Y, Oshima Y, Maeda K (2016) Surgical intervention strategies for congenital tracheal stenosis associated with a tracheal bronchus based on the location of stenosis. Pediatr Surg Int 32(9):915–919

    Article  Google Scholar 

  6. Yokoi A, Arai H, Bitoh Y, Nakao M, Oshima Y, Nishijima E (2012) Aortopexy with tracheal reconstruction for postoperative tracheomalacia in congenital tracheal stenosis. J Pediatr Surg 47(6):1080–1083

    Article  Google Scholar 

  7. Toma M, Kamagata S, Hirobe S, Komori K, Okumura K, Mutoh M, Hayashi A (2009) Modified slide tracheoplasty for congenital tracheal stenosis. J Pediatr Surg 44(10):2019–2022

    Article  Google Scholar 

  8. Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48(3):452–458

    Article  CAS  Google Scholar 

  9. Barat M, Konrad HR (1987) Tracheal bronchus. Am J Otolaryngol 8(2):118–122

    Article  CAS  Google Scholar 

  10. Wang S, Zhang H, Zhu L, Zhen J, Liu J, Xu Z (2016) Surgical management of congenital tracheal stenosis associated with tracheal bronchus and congenital heart disease. Eur J Cardiothorac Surg 49(4):1201–1206

    Article  Google Scholar 

  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(2):325–328

    Article  Google Scholar 

  12. Stock C, Nathan M, Murray R, Rahbar R, Fynn-Thompson F (2015) Modified end-to-end anastomosis for the treatment of congenital tracheal stenosis with a bridging bronchus. Ann Thorac Surg 99(1):346–348

    Article  Google Scholar 

  13. Beierlein W, Elliott MJ (2006) Variations in the technique of slide tracheoplasty to repair complex forms of long-segment congenital tracheal stenoses. Ann Thorac Surg 82(4):1540–1542

    Article  Google Scholar 

  14. Salassa JR, Pearson BW, Payne WS (1977) Gross and microscopical blood supply of the trachea. Ann Thorac Surg 24(2):100–107

    Article  CAS  Google Scholar 

  15. Tuo G, Volpe P, Bava GL, Bondanza S, De Robertis V, Pongiglione G, Marasini M (2009) Prenatal diagnosis and outcome of isolated vascular rings. Am J Cardiol 103(3):416–419

    Article  Google Scholar 

  16. Berdon WE, Baker DH, Wung JT, Chrispin A, Kozlowski K, de Silva M, Bales P, Alford B (1984) Complete cartilage-ring tracheal stenosis associated with anomalous left pulmonary artery: the ring-sling complex. Radiology 152(1):57–64

    Article  CAS  Google Scholar 

  17. Cohen SR, Landing BH (1976) Tracheostenosis and bronchial abnormalities associated with pulmonary artery sling. Ann Otol Rhinol Laryngol 85(5 Pt. 1):582–590

    Article  CAS  Google Scholar 

  18. 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(4):1334–1338

    Article  Google Scholar 

  19. Muraji T, Satoh S, Tsugawa C, Moriuchi T, Yamaguchi M, Matamoros MA, Nishijima E, Suzuki T, Murata H (1998) Slide tracheoplasty: a case report of successful concomitant reconstruction of extensive congenital tracheal stenosis and pulmonary artery sling. J Pediatr Surg 33(11):1658–1659

    Article  CAS  Google Scholar 

  20. Airway Reconstruction T (2005) Recent challenges in the management of congenital tracheal stenosis: an individualized approach. J Pediatr Surg 40(5):774–780

    Article  Google Scholar 

  21. Chiu PP, Rusan M, Williams WG, Caldarone CA, Kim PC (2006) Long-term outcomes of clinically significant vascular rings associated with congenital tracheal stenosis. J Pediatr Surg 41(2):335–341

    Article  Google Scholar 

Download references

Acknowledgements

We thank Mr. Brian Quinn for his comments and help with the manuscript. The authors are very grateful to Hidetoshi Fukui for his excellent drawings.

Author information

Authors and Affiliations

  1. Department of Surgery, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan

    Toshio Harumatsu, Naoki Shimojima, Hirofumi Tomita, Akihiro Shimotakahara, Koji Komori & Seiichi Hirobe

  2. Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan

    Toshio Harumatsu & Satoshi Ieiri

Authors
  1. Toshio Harumatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naoki Shimojima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hirofumi Tomita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akihiro Shimotakahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Koji Komori
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Satoshi Ieiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seiichi Hirobe
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

T.H. and S.I. wrote the main manuscript text. N.S. and A.S. collected the patients information, and K.K. and S.H. prepared the study design. H.T. prepared figures 1-4. All authors reviewed the manuscript.

Corresponding author

Correspondence to Satoshi Ieiri.

Ethics declarations

Competing interests

The authors declare no competing interests.

Conflict of interest

The authors declare no conflicts of interest in association with the present study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harumatsu, T., Shimojima, N., Tomita, H. et al. Successful surgical treatment of congenital tracheal stenosis combined with tracheal bronchus and left pulmonary artery sling: a 10-year single-institution experience. Pediatr Surg Int 38, 1363–1370 (2022). https://doi.org/10.1007/s00383-022-05161-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-022-05161-8

Keywords

Search

Navigation