1. Combined Surgical and Endoscopic Approach for Ring-Sling Complex.
- Author
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Porcedda G, Brambilla A, Favilli S, Murzi B, Mirabile L, Baggi R, and Arcieri L
- Subjects
- Bronchi diagnostic imaging, Bronchi surgery, Bronchial Diseases diagnostic imaging, Bronchial Diseases mortality, Bronchoscopy adverse effects, Bronchoscopy instrumentation, Bronchoscopy mortality, Child, Child, Preschool, Constriction, Pathologic diagnostic imaging, Constriction, Pathologic mortality, Female, Heart Defects, Congenital diagnostic imaging, Heart Defects, Congenital mortality, Humans, Infant, Male, Postoperative Complications mortality, Postoperative Complications therapy, Pulmonary Artery abnormalities, Pulmonary Artery diagnostic imaging, Retrospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Stents, Time Factors, Tracheal Stenosis diagnostic imaging, Tracheal Stenosis mortality, Treatment Outcome, Bronchi abnormalities, Bronchial Diseases surgery, Cardiac Surgical Procedures adverse effects, Cardiac Surgical Procedures mortality, Constriction, Pathologic surgery, Costal Cartilage transplantation, Heart Defects, Congenital surgery, Pulmonary Artery surgery, Plastic Surgery Procedures adverse effects, Plastic Surgery Procedures mortality, Replantation adverse effects, Replantation mortality, Tracheal Stenosis surgery
- Abstract
Background: Left pulmonary artery (LPA) sling (PAS) is a vascular ring, which is frequently associated with long-segment tracheal stenosis (TS). Mortality rate in operated children is still high, especially in cases of severe tracheal hypoplasia and/or associated congenital heart defects (CHDs). We report our experience of treatment and follow-up in a pediatric cohort of patients affected by PAS with severe tracheobronchial involvement., Methods: From 2005 to 2017, we enrolled 11 children diagnosed with PAS and congenital TS requiring surgical intervention. Echocardiography, computed tomography, and bronchoscopy were performed in all patients. Associated CHD were present in 5 (45%) patients. Tracheal reconstruction techniques included slide tracheoplasty (7/11; 63%), slide tracheoplasty and costal cartilage graft (2/11; 18%), and Hazekamp technique (2/11; 18%).Nine patients underwent LPA direct reimplantation and concomitant tracheoplasty; concomitant surgical repair for CHD was performed in three children., Results: Over a mean follow-up of 30 months (range: 3-75 months), a late mortality of 18% was registered; no early death occurred. Good flow through LPA could be documented in all patients. Ten children required operative bronchoscopies (mean: 16/patients) aimed at stent positioning/removal, treatment of granulomas, and tracheobronchial dilatation., Conclusions: Severe tracheobronchial stenosis and associated CHD were the main determinants for hospitalization time, intensive assistance, and repeated endoscopic procedures.Patients affected by PAS/TS complex require a careful management at high-specialized centers providing multidisciplinary team.Respiratory endoscopy may play a central role both in preoperatory assessment and in postoperative management of patients showing severe tracheobronchial involvement., Competing Interests: None., (Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2020
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