Loukanov Tsvetomir, Sebening Christian, Springer Wolfgang, Ulmer Herbert, Hagl Siegfried
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany.
J Thorac Cardiovasc Surg. 2005 Dec;130(6):1537-41. doi: 10.1016/j.jtcvs.2005.08.031.
The present article aims to describe our experience with patients who underwent simultaneous repair of congenital tracheal stenosis and cardiac anomalies.
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.
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.
We advocate our current strategy for infants with congenital tracheal stenosis: resection with end-to-end anastomosis and simultaneous repair of associated intracardiac anomalies.
本文旨在描述我们对同时接受先天性气管狭窄和心脏畸形修复手术患者的治疗经验。
2000年1月至2003年12月期间，9例婴儿同时接受了先天性气管狭窄和先天性心脏病的手术修复。术中发现3例患者存在局限性气管狭窄。6例患者为漏斗型气管狭窄。相关心脏畸形包括5例继发孔房间隔缺损、2例室间隔缺损、4例肺动脉吊带、6例动脉导管未闭、1例房室间隔缺损、1例主动脉弓发育不全、1例主动脉缩窄以及2例部分性肺静脉异位连接，其中1例伴有“弯刀综合征”。2例患者诊断为右上叶气管起源。1例患者发现右迷走锁骨下动脉（lusoria）。所有患者均通过正中胸骨切开术并在体外循环下进行手术。所有病例均进行了气管切除并直接端端吻合。
无手术死亡病例。1例患者术后6周死亡。8例患者在术后第14天至第30天期间在支气管镜监测下拔除气管插管。拔管是在逐步撤离呼吸机程序后进行的。术后内镜检查显示每个病例气道尺寸合适且通畅。对整个组平均随访37个月（范围16 - 58个月）的中期结果显示临床结局稳定且无并发症。
我们提倡对先天性气管狭窄婴儿采用当前策略：进行端端吻合切除并同时修复相关心脏内畸形。
