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Tsvetomir Loukanov
Christian Sebening
Siegfried Hagl
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Right arrow Trachea and bronchi
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J Thorac Cardiovasc Surg 2005;130:1537-1541
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Simultaneous management of congenital tracheal stenosis and cardiac anomalies in infants

Tsvetomir Loukanov, MD a , * , Christian Sebening, MD a , Wolfgang Springer, MD b , Herbert Ulmer, MD, PhD b , Siegfried Hagl, MD, PhD a

a Departments of Cardiac Surgery and Paediatric Cardiology,
b University of Heidelberg, Heidelberg, Germany

Received for publication June 5, 2005; revisions received July 8, 2005; accepted for publication August 23, 2005.

* Address for reprints: Tsvetomir Loukanov, MD, Department of Cardiac Surgery, Surgical Clinic, INF 110, 69120 Heidelberg, Germany (Email: tsloukanov{at}abv.bg).

OBJECTIVE: The present article aims to describe our experience with patients who underwent simultaneous repair of congenital tracheal stenosis and cardiac anomalies.

METHODS: Between January 2000 and December 2003, 9 infants underwent simultaneous surgical repair of a congenital tracheal stenosis and congenital heart disease. The intraoperative findings revealed localized tracheal stenosis in 3 patients. The funnel-type tracheal stenosis was present in 6 patients. Associated cardiac anomalies included ostium secundum atrial septal defect in 5 patients and ventricular septal defect in 2 patients, pulmonary artery sling in 4 patients, patent ductus arteriosus in 6 patients, atrioventricular septal defect in 1 patient, aortic arch hypoplasia in 1 patient, coarctation of the aorta in 1 patient, and partial anomalous pulmonary venous connection in 2 patients, one of them with "scimitar syndrome." Tracheal origin of the right upper lobe was diagnosed in 2 of the patients. A right aberrant subclavian artery (lusoria) was found in one patient. All patients were operated on through a median sternotomy and with cardiopulmonary bypass. Tracheal resection with direct end-to-end anastomosis was performed in all cases.

RESULTS: There was no operative mortality. One patient died 6 weeks postoperatively. Eight patients were extubated between the 14th and 30th postoperative days under bronchoscopic monitoring. The extubation was performed after a stepwise respirator-weaning program. Postoperative endoscopic examination showed adequate airway dimensions and patency in every case. The midterm results after a mean follow-up of 37 months (range, 16-58 months) of the entire group demonstrate a stabile and complication-free clinical outcome.

CONCLUSIONS: We advocate our current strategy for infants with congenital tracheal stenosis: resection with end-to-end anastomosis and simultaneous repair of associated intracardiac anomalies.

Abbreviations and Acronyms ASD = atrial septal defect; AVSD = atrioventricular septal defect; CPB = cardiopulmonary bypass; CTS = congenital tracheal stenosis; LPA = left pulmonary artery; PA = pulmonary artery; VSD = ventricular septal defect




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