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J Thorac Cardiovasc Surg 2001;122:403-404
© 2001 The American Association for Thoracic Surgery
Letters to the Editor |
Centre Hospitalier Universitaire Vaudois, 46 rue du Bugnon, CH-1011
Lausanne, Switzerland
To the Editor:
In a recent issue of the Journal, Garabédian and colleagues
1 reported the case of an infant who underwent repair of a ventricular septal defect (VSD) at 2 months of age and subsequently, at 4 months of age, was successfully treated by slide tracheoplasty with the aid of cardiopulmonary bypass for tracheal stenosis with complete tracheal rings.
From the information available in the case report, it is not possible to know whether the infant had respiratory problems at the time of the VSD repair or whether the trachea remained intubated after that surgical procedure. Of course, we are well aware of the potential association of congenital tracheal stenosis and heart defects. 2 Nevertheless, from the available imaging of the reported preoperative investigations (bronchography and endoscopy), it is easy to believe that the interval between VSD repair and slide tracheoplasty was characterized by respiratory problems.
In our experience, published in part 2 years ago, 3 we were able to repair congenital heart defects and long-segment tracheal stenosis with a 1-stage surgical approach in 4 children, mean age 22 months (8 months–3 years), mean weight 8.4 kg (5.3-12.0 kg), with preoperative mechanical ventilation up to 3 months. The diagnoses were as follows: dextrocardia, atrial septal defect, and persistent left superior vena cava (n = 1); atrial septal defect and pulmonary artery sling (n = 1); VSD (n = 1); and double-outlet right ventricle with VSD, pulmonary atresia, patent ductus arteriosus, and persistent left superior vena cava draining into the left auricular appendage (n = 1). Tracheal stenosis with circular rings extended to 80% of the tracheal length in two children, 75% in one, and 66% in one. The internal tracheal diameter was 2 mm in one, 3 mm in two, and 4 mm in one. Slide tracheoplasty and intracardiac repair, in one case requiring a right ventricle–pulmonary artery conduit, was performed in all children with a single period of cardiopulmonary bypass (mean duration 165 minutes; range 145-189 minutes). There were no early or late deaths. Mean stay in the intensive care unit was 6.5 days (range 4-11 days), with tracheal extubation after a mean period of 54 hours (range 48-72 hours). Mean hospital discharge was 16 days (range 15-18 days). Endoscopic examination showed a 4.4-mm (3.0-5.5 mm) mean increase in internal tracheal diameter, equivalent to a mean 160% of preoperative size (75%-250%). Endoscopic excision of endoluminal tissue was required twice in one child and once in two. All children remain well, without medication and respiratory problems, with a mean follow-up of 40 months (range 19-64 months).
From our experience it is evident that we support the authors' choice of the slide tracheoplasty as the preferred technique for long-segment tracheal stenosis. However, we would like to add to their conclusions the fact that, in the case of associated congenital heart disease, even complex, 1-stage repair of the congenital heart defect and slide tracheoplasty is feasible and provides adequate treatment of both the cardiac and tracheal problems.
12/8/116555
References
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