El-Said Howaida, Price Katherine, Hussein Amira, Ganta Srujan, Rao Aparna, Nigro John, Brigger Matthew T
Pediatric Cardiology, Rady Children's Hospital, San Diego, California.
University of California San Diego School of Medicine, San Diego, California.
J Soc Cardiovasc Angiogr Interv. 2023 Jul 11;2(5):101068. doi: 10.1016/j.jscai.2023.101068. eCollection 2023 Sep-Oct.
Treatment of tracheobronchial disease in medically complex infants with congenital heart disease (CHD) is often challenging. When conservative management or surgery fails or is contraindicated, airway stenting can allow for advancement of care or weaning of respiratory support.
We identified 8 cases of airway stenting with balloon-expandable coronary bare-metal stents performed at our institution between February 2019 and September 2022 to relieve conservative treatment-refractory tracheobronchial disease in pediatric patients with CHD. All patients underwent rigid microlaryngoscopy, bronchoscopy, and flexible bronchoscopy as well as computed tomography angiography.
Eight patients underwent technically uncomplicated placement of balloon-expandable coronary bare-metal stents in the trachea or bronchus. Immediate improvement in respiratory parameters was noted following stent placement. Six patients were able to wean mechanical ventilation following stent placement, with a median of 2.5 days of mechanical ventilation following the procedure (range, 0-219). All stents were subsequently endoscopically removed at a median of 6.8 months (range, 0.4-16.3 months). In 6 patients, bronchoscopy after stent removal demonstrated a rounder configuration of the airway consistent with bronchial remodeling.
In pediatric patients with tracheobronchial and CHD, airway stenting with balloon-expandable bare-metal coronary stents relieved respiratory symptoms with minimal complications and resulted in bronchial remodeling after stent removal.
对于患有先天性心脏病（CHD）且病情复杂的婴儿，气管支气管疾病的治疗通常具有挑战性。当保守治疗或手术失败或禁忌时，气道支架置入可促进治疗进展或减少呼吸支持。
我们确定了2019年2月至2022年9月期间在我院进行的8例使用球囊扩张冠状动脉裸金属支架进行气道支架置入的病例，以缓解患有CHD的儿科患者中保守治疗难治的气管支气管疾病。所有患者均接受了硬质显微喉镜检查、支气管镜检查和柔性支气管镜检查以及计算机断层血管造影。
8例患者在气管或支气管中成功置入球囊扩张冠状动脉裸金属支架，技术操作无并发症。支架置入后呼吸参数立即得到改善。6例患者在支架置入后能够撤机，术后机械通气时间中位数为2.5天（范围为0 - 219天）。所有支架随后在内镜下取出，中位数为6.8个月（范围为0.4 - 16.3个月）。6例患者在支架取出后进行支气管镜检查，显示气道形态更圆润，符合支气管重塑。
在患有气管支气管疾病和CHD的儿科患者中，使用球囊扩张裸金属冠状动脉支架进行气道支架置入可缓解呼吸症状，并发症最少，并在支架取出后导致支气管重塑。
