Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Pediatrics, Ningbo Hangzhou Bay Hospital, Ningbo, Zhejiang, China.
Pediatr Cardiol. 2024 Aug;45(6):1334-1342. doi: 10.1007/s00246-023-03118-9. Epub 2023 Mar 11.
The indications and surgical techniques for airway stenosis (AS) repair among patients with bridging bronchus (BB) and congenital heart disease (CHD) have not been fully established. We sought to provide our experience with tracheobronchoplasty in a large series of BB patients with AS and CHD. Eligible patients were retrospectively enrolled from June 2013 to December 2017 and were followed up to December 2021. Epidemiological, demographic, clinical, imaging, surgical management, and outcome data were obtained. 5 tracheobronchoplasty techniques including 2 novel modified ones were performed. We included 30 BB patients with AS and CHD. Tracheobronchoplasty was indicated in them. 27 (90%) patients underwent tracheobronchoplasty. But 3 (10%) refused AS repair. 4 subtypes of the BB and 5 main sites of AS were identified. 6 (22.2%) cases, including one death, had severe postoperative complications associated with being underweight at surgery, preoperative mechanical ventilation, and more types of CHD. 3 cases were lost to follow-up. 18 (78.3%) of the survivors remained asymptomatic, and 5 (21.7%) had stridor, wheezing, or polypnea after exercise. 2 patients out of the three who did not undergo airway surgery died, and the one survivor had a poor quality of life. Good outcomes can be achieved in BB patients with AS and CHD who undergo proper tracheobronchoplasty techniques guided by specified criteria, but severe postoperative complications should be well managed.
桥支气管(BB)合并先天性心脏病(CHD)患者的气道狭窄(AS)修复的适应证和手术技术尚未完全确立。我们旨在为大量 BB 合并 AS 和 CHD 患者提供我们在气管支气管成形术中的经验。从 2013 年 6 月至 2017 年 12 月,回顾性招募符合条件的患者,并随访至 2021 年 12 月。获取了流行病学、人口统计学、临床、影像学、手术管理和结果数据。进行了 5 种气管支气管成形术技术,包括 2 种新型改良技术。我们纳入了 30 例 BB 合并 AS 和 CHD 的患者。他们需要进行气管支气管成形术。27 例(90%)患者接受了气管支气管成形术。但 3 例(10%)拒绝进行 AS 修复。确定了 4 种 BB 亚型和 5 种主要的 AS 部位。6 例(22.2%)患者出现与手术时体重过轻、术前机械通气和更多类型的 CHD 相关的严重术后并发症,包括 1 例死亡。3 例失访。18 例(78.3%)幸存者无症状,5 例(21.7%)运动后出现喘鸣、哮鸣或呼吸急促。未行气道手术的 3 例患者中有 2 例死亡,1 例幸存者的生活质量较差。在符合特定标准的指导下,对 BB 合并 AS 和 CHD 患者进行适当的气管支气管成形术技术可以取得良好的效果,但应妥善处理严重的术后并发症。