Original articlePediatric cardiacInfluence of Tracheobronchomalacia on Outcome of Surgery in Children With Congenital Heart Disease and Its Management
Section snippets
Material and Methods
Clinical records of two groups of pediatric patients who underwent cardiac surgery for congenital heart disease between June 1998 and December 2003 in our institution were reviewed. After consultation with the local ethics committee we were advised that as the study was an anonymous, retrospective service evaluation, formal ethical committee approval was not required. Of a cohort of 1,578 patients undergoing surgery for congenital heart disease in our unit during this time (1,094 open and 484
Results
In 12 patients the diagnosis of TBM was made preoperatively owing to respiratory distress requiring ventilation (n = 6), gastroesophageal reflux (n = 2), stridor (n = 3), or dyspnea (n = 1). The diagnosis was made postoperatively in 10 patients after failed extubation (n = 8), or because of gastroesophageal reflux (n = 1) or stridor (n = 1).
Bronchoscopy was performed in 19 patients (86%), and dynamic contrast tracheobronchography in 9 patients (41%). The diagnosis of TBM was confirmed solely by
Comment
Tracheobronchomalacia, although rare, is a common and important cause of persistent ventilatory requirement in infancy with a reported incidence of up to 50% [5, 6, 7, 8]. Children may present with clinical signs of airway obstruction, such as stridor, wheeze, cyanotic spells, and reflex apnea, or recurrent respiratory tract infections [3]. However, it may remain silent until the postoperative period when it becomes manifest by difficulty in ventilation or unexpected requirement for prolonged
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2021, Journal of Thoracic and Cardiovascular SurgeryCleft-lip-plate patient with tracheobronchomalacia: A case report and review of the literature in Japan
2020, JPRAS OpenCitation Excerpt :TBM had often been found as these patients suffered from difficulty of weaning from mechanical ventilation and/or extubation. This suggests that TBM should be suspected in patients with unexpected postoperative respiratory difficulty.39 In general, tracheal intubation or tracheostomy are recommended strategies for dyspnea due to airway constriction.
Tracheostomy Among Infants With Hypoplastic Left Heart Syndrome Undergoing Cardiac Operations: A Multicenter Analysis
2017, Annals of Thoracic SurgeryCitation Excerpt :Similar risk factors were previously identified in tracheostomy patients with diverse heart lesions [1, 8–10, 12]. Because the mortality rate of infants with tracheostomy remains elevated across the study era, more emphasis needs to be placed on potentially alleviating the risk factors for this procedure [13]. In addition, we identified specific characteristics among survivors.
Advances in Surgical Treatment of Congenital Airway Disease
2016, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :Severe TBM occurs frequently with absent pulmonary valve syndrome and vascular ring pathology, but also with many other variants of CHD. Among patients undergoing surgery for CHD, TBM is associated with increased duration of mechanical ventilation, intensive care unit stay, and mortality.8,9 The guiding principle of intervention in TBM is to improve airway function and clinical status of the patient.