Wise-Faberowski Lisa, Irvin Matthew, Sidell Douglas R, Rajashekara Sheila, Asija Ritu, Chan Frandics P, Hanley Frank L, McElhinney Doff B
Department of Anesthesiology,Stanford University, Palo Alto,CA,USA.
Clinical and Translational Research Program, Betty Moore heart Center, Palo Alto, CA,USA.
Cardiol Young. 2019 May;29(5):610-614. doi: 10.1017/S1047951119000301. Epub 2019 May 2.
Children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals (TOF/MAPCAs) are at risk for post-operative respiratory complications after undergoing unifocalisation surgery. Thus, we assessed and further defined the incidence of airway abnormalities in our series of over 500 children with TOF/MAPCAs as determined by direct laryngoscopy, chest computed tomography (CT), and/or bronchoscopy.
The medical records of all patients with TOF/MAPCAs who underwent unifocalisation or pulmonary artery reconstruction surgery from March, 2002 to June, 2018 were reviewed. Anaesthesia records, peri-operative bronchoscopy, and/or chest CT reports were reviewed to assess for diagnoses of abnormal or difficult airway. Associations between chromosomal anomalies and airway abnormalities - difficult anaesthetic airway, bronchoscopy, and/or CT findings - were defined.
Of the 564 patients with TOF/MAPCAs who underwent unifocalisation or pulmonary artery reconstruction surgery at our institution, 211 (37%) had a documented chromosome 22q11 microdeletion and 28 (5%) had a difficult airway/intubation reported at the time of surgery. Chest CT and/or peri-operative bronchoscopy were performed in 234 (41%) of these patients. Abnormalities related to malacia or compression were common. In total 35 patients had both CT and bronchoscopy within 3 months of each other, with concordant findings in 32 (91%) and partially concordant findings in the other 3.
This is the largest series of detailed airway findings (direct laryngoscopy, CT, and bronchoscopy) in TOF/MAPCAS patients. Although these findings are specific to an at-risk population for airway abnormalities, they support the utility of CT and /or bronchoscopy in detecting airway abnormalities in patients with TOF/MAPCAs.
患有法洛四联症、肺动脉闭锁及主-肺动脉侧支（TOF/MAPCAs）的儿童在接受单灶化手术术后有发生呼吸并发症的风险。因此，我们评估并进一步明确了在我们这组超过500例TOF/MAPCAs患儿中，通过直接喉镜检查、胸部计算机断层扫描（CT）和/或支气管镜检查所确定的气道异常发生率。
回顾了2002年3月至2018年6月期间所有接受单灶化或肺动脉重建手术的TOF/MAPCAs患者的病历。查阅麻醉记录、围手术期支气管镜检查报告和/或胸部CT报告，以评估是否存在气道异常或困难气道的诊断。明确了染色体异常与气道异常（困难麻醉气道、支气管镜检查和/或CT表现）之间的关联。
在我们机构接受单灶化或肺动脉重建手术的564例TOF/MAPCAs患者中，211例（37%）记录有22号染色体q11微缺失，28例（5%）在手术时有困难气道/插管的报告。其中234例（41%）患者进行了胸部CT和/或围手术期支气管镜检查。与软化或受压相关的异常很常见。共有35例患者在3个月内先后进行了CT和支气管镜检查，其中32例（91%）结果一致，另外3例部分一致。
这是关于TOF/MAPCAS患者详细气道检查结果（直接喉镜检查、CT和支气管镜检查）的最大系列研究。尽管这些结果是特定于气道异常高危人群的，但它们支持CT和/或支气管镜检查在检测TOF/MAPCAs患者气道异常方面的实用性。
