Case report
Polyflex™ stenting of tracheomalacia after surgery for congenital tracheal stenosis

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Summary

Polyflex™ self-expanding stents (Rüsch, Germany) were used in three young children who had presented with life-threatening long-segment tracheal stenosis with bronchial stenosis in two cases. Two children had slide tracheoplasties and subsequently aortic homografts and another tracheal resection and autotracheoplasty. However, in all cases persistent lower tracheal malacia necessitated stenting. Complications of granuloma, stent migration or dislodgement occurred in all cases. A fatal tracheo-aortic fistula occurred in one child. Granuloma in one was treated successfully with steroids. One child survives.

Introduction

Management of complex airway pathology in children is difficult and requires a dedicated multidisciplinary approach. We describe our experiences with several children with long-segment tracheal stenosis and the use of Polyflex stenting to manage malacia after failed surgical correction.

Section snippets

Case 1

A 17-month-old child presented with severe airway obstruction exacerbated by viral infection. Stridor from 3 months of age was due to 2 mm long-segment stenosis involving five complete rings and right main bronchial stenosis (3.5 mm) associated with left pulmonary artery sling. Veno-arterial extracorporeal membrane oxygenation (v-aECMO) was required after failure of conventional mechanical ventilation and high frequency oscillatory ventilation.

The sling was repaired and slide tracheoplasty

Comment

Management of long-segment congenital tracheal stenosis and malacia is determined by the degree of obstruction, length of involvement, involvement of the bronchi and presence or absence of complete tracheal rings [1].

Initial slide tracheoplasty [2] is recommended for medium-length stenosis (<2/3 trachea) with 28 survivors among 32 cases [1]. For long-segment stenosis, slide tracheoplasty with patch is required. Numerous patch materials and tissues have been utilised with good results from

References (13)

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