Search

Enlarged cardiac structures, especially those on left side have the potential to cause airway compression in pediatric patients with chronic heart failure, owing to their proximity to and impact on the trachea-bronchial tree. Ventricular assist devices are effective in decompressing such hearts thereby alleviating airway problems. Aortopexy serves as an effective airway decompressive measure in cases with persistent airway compression despite effective cardiac decompression by ventricular assist devices. We report a case of 1-year-old male patient with dilated cardiomyopathy in whom airway compression persisted despite ventricular assist device implantation. Aortopexy was effective in relieving airway compression allowing for subsequent extubation and successful heart transplantation.

Graphical abstract, Highlights • Severe complications from TEE imaging are uncommon. • Airway compression from TEE occurs in children and as rare case reports in adults. • This can be caused by an anteflexed probe in an adult with tracheobronchomalacia.

Purpose To evaluate the safety and efficacy of computed tomography (CT)-guided 125I radioactive seed implantation in patients with malignant airway compression induced by advanced lung cancer. Material and methods Between June 2015 and June 2018, 40 patients from three medical institutions with malignant airway compression induced by advanced lung cancer were treated with 125I seed implantation. The outcomes were measured in technical success and safety, objective response rate, complications, Karnofsky performance status (KPS) score, and survival time. Results All 40 patients successfully underwent implantation procedure. No procedure-associated death occurred. The most common complications were irritable cough, temporary hemoptysis, chest pain, fever, and pneumothorax, which occurred in 26 (65.0%), 31 (77.5%), 12 (30.0%), 15 (37.5%), and 11 (27.5%) patients, respectively. The objective response rates were 100%, 100%, 100%, 87.5%, and 83.3% at the 3rd, 6th, 12th, 24th, and 36th months post-procedure, respectively. The KPS score significantly improved at post-procedure. Median survival time was 25.1 months. Actuarial survival rates were 100%, 60%, and 15% at the 12th, 24th, and 36th months after the procedure, respectively. Conclusions For patients with malignant airway compression induced by advanced lung cancer, implantation with 125I seed is a safe and effective alternative treatment option.

Background The condition of mediastinal chondrosarcoma causing severe airway compression has never been reported before, and its complexity makes its surgical management challenging. We implemented two new techniques to overcome this problem. Creative mockup analogy of a distorted trachea and tumor lesion using a 3-D printing module, with reprogramming by computed tomography, streamlined the panorama with intricate correlation. Case presentation Our patient was a previously healthy 52-year-old slender yellow man who had no obvious medical history. In the last 3 years, upper respiratory tract infection and productive cough were noted frequently, and the patient’s symptoms were aggravated with shortness of breath when his head was positioned below 90 degrees during squatting and hunching of the body. The patient manifested prone sleep with ashen complexion, and he had lost 3–4 kg of body weight over the 3 weeks before admission to our hospital. Virtual bronchoscopy with computed tomography revealed an 8.3 × 7.5 × 4-cm lobulated right upper mediastinal mass with amorphous calcification and severe, intricate airway compression. A creative mockup analogy module of the distorted trachea and tumor was generated by 3-D printing and reprogrammed by computed tomography to streamline the sophisticated correlation. The patient underwent a two-stage operation comprising stabilization of the airway for innovative T-tube insertion preceded by thoracoscopy-assisted radical removal of the tumor. Postoperative adjuvant radiotherapy was administered. The patient recovered uneventfully and stayed healthy for 2 solid years in follow-up. Conclusions An advanced 3-D printing model provides affirmative information related to treatment strategy and is also a prospective tool for better doctor–patient communication regarding the disease.

Introduction Giant thoracic aortic aneurysms and aortic arch dissections are accompanied by high mortality rates, cardiac and neurologic events and pulmonary complications. Tracheobronchial compression with aorta-tracheal fistula is a rare complication of the aorta aneurysms. Aortic arch replacement in such case presents several formidable challenges. Presentation of case This is the case report of successful surgical treatment of giant aortic arch aneurysm, complicated by airway compression, aorta-tracheal fistula and recurrent community-acquired pneumonia. Discussion Urgent indications for the aortic arch aneurysms surgery include significant size and high risk of rupture. As well as a visceral compression are presented. Bronchoscopy can be used to successfully treatment at all stages from trachea intubation to extubation. Conclusion Aggressive surgical approach with careful pre-operative diagnostic are the key to success and the only one chance for patients with aortic arch aneurysm, complicated by airway compression., Highlights • Aorta-tracheal fistula is rare and formidable complication of the aortic aneurysms. • A giant thoracic aortic aneurism leads to bronchial compression and pneumonia. • Airway compression syndrome is an independent predictor of emergency surgery.

In recent years, external stenting has been used as a reliable method to relieve airway compression of the trachea and main bronchi in young children with acceptable age-proportional airway growth. However, to our knowledge, no literature supporting this approach for the distal airway has been published. A 1-year-old girl with absent pulmonary valve syndrome who had recurrent respiratory infections was diagnosed with bronchomalacia. She underwent an external stenting; the infections disappeared postoperatively. This is the first reported case of successful external stenting for malacia of the bronchus intermedius, which exhibited short- and mid-term safety and effectiveness.

The airway compression poses a challenge for the anesthesiologist in airway management during aneurysm repair surgery.

We are focusing on three things for every patient in the hospital with COVID-19, namely dexamethasone, remdesivir and enhanced anticoagulation protocols as this had shown improved mortality. However, the bleeding risk in these patients has not been taken into consideration. In our ICU setting at Rochester General hospital, we have seen too many cases with gastrointestinal bleeding and hemoptysis in COVID-19 patients. In this case, we report bleeding related to central access removal related to coagulation inhibitors that lead to airway compression. The aim of this case is to keep bleeding tendency of COVID-19 patients on the radar and to delineate that it has clear severe consequences just as clotting.

The Norwood procedure is the first of three palliative surgical procedures offered for hypoplastic left heart syndrome (HLHS). Due to the small size of the thorax and proximity of airway and vascular structures, compression of the airway is possible following the Norwood procedure. We describe the management of an infant with HLHS following Stage I surgical palliation who developed refractory respiratory failure secondary to severe left bronchial compression.

The objective of this article is to improve the etiology verification of the obstruction in young children by informing the physicians about the rare causes of obstructive syndrome which are difficult to diagnose, in particular about tuberculosis. Analyzed the clinical and medical history girls 6 months, presented data on the treatment and examination of the patient. The survey revealed that the main pathogenetic mechanism of bronchial obstruction of airway compression was increased bronchopulmonary lymph nodes on the background of specific tubercular process in lungs.

Purpose: Children with congenital heart disease may present with severe airway compression prior to any surgical procedure or may develop airway compression following their surgical procedure. This combination of congenital heart defect and airway compression poses a significant management challenge. The purpose of this study was to review our experience with the Lecompte procedure for relief of severe airway compression. Methods: This was a retrospective review of ten patients who underwent a Lecompte procedure for relief of severe airway compression over the past nine years (2010-2018). Three patients with absent pulmonary valve syndrome presented with severe symptoms prior to any surgical procedure. Seven patients presented with symptoms of airway compression following repair of their congenital heart defects (one with absent pulmonary valve syndrome, three patients had repair of pulmonary atresia with ventricular septal defect, and three patients had undergone aortic arch surgery). The median age at presentation was two years (range: one day to seven years). Results: The ten patients underwent a Lecompte procedure without any significant complications or operative mortality. The median interval between the surgical procedure and extubation was 9.5 days. No patients have required any further interventions for relief of airway obstruction. Conclusions: The Lecompte procedure is a surgical option for young children who present with severe airway compression. The patients in this series responded well to the Lecompte procedure as evidenced by clinical relief of airway compression.

Double aortic arch (DAA) is a rare disease requiring high index of clinical suspicion for diagnosis. If undiagnosed, it can pose a serious challenge during anesthetic induction because of dynamic nature of tracheal compression. When DAA is associated with other congenital heart diseases, anesthetic management becomes even more challenging. We report the perioperative anesthetic management of a very rare case of DAA associated with pentalogy of Fallot.

Intra-thoracic desmoid tumors are exceedingly rare tumors in the pediatric population, and can present with compression of cardiopulmonary structures and respiratory compromise. Surgical and anesthetic management of these tumors are challenging. We report the case of a 14-year-old male who presented with dyspnea, found to have a large intra-thoracic mass that was critically compressing his trachea. We provide a review of the literature of desmoid tumors and discuss the management of intra-thoracic masses.

Transcatheter aortic valve replacement (TAVR) is an alternative to traditional surgery in patients considered to be at high or intermediate risk for open surgical repair of aortic stenosis. Despite its overall safety and efficacy, TAVR is associated with potentially serious complications including major vascular injury. Tracheal compression resulting from vascular pathology has been previously reported; however, airway compromise secondary to vascular injury during TAVR has not been described. We report a case of airway compression and respiratory compromise resulting from injury to the right subclavian artery during TAVR.

Airway compression due to distal aortic arch and descending aortic aneurysm repair has been documented. This case of tracheal and left main stem bronchus compression due to aortic aneurysm occurred in a 42-year-old man. The airway compression poses a challenge for the anesthesiologist in airway management during aortic aneurysm repair surgery. The fiber-optic bronchoscope is very helpful in decision-making both preoperatively and postoperatively in such cases. We report a case of airway compression in a 42-year-old patient who underwent elective distal aortic arch and descending aortic aneurysm repair.

Tracheal compression by vascular structures in infants is uncommon and may be masked by nonspecific respiratory symptoms. Double aortic arch (DAA) is the most common vascular ring. We describe a case of a 9-month-old male infant presented with respiratory distress and found to have a DAA. In this report, the authors emphasize the consideration of this pathology-induced respiratory distress and discuss its anesthetic management.

Symptoms of airway compression secondary to double aortic arch are relieved by division of one of the two aortic arches. However, in some cases inherent tracheomalacia and other factors may result in persistence of symptoms. We report one such occurrence in our experience and describe the use of aortopexy as a curative procedure to tackle this problem.

In developed countries, surgeons and anesthesiologists approach the mediastinal mass causing airway compression with prudence and trepidation. Resource-limited settings provide unique challenges in the diagnosis and management of patients with critical airway compression. We report the successful treatment of a patient in Port-au-Prince, Haiti with a posterior mediastinal mass that filled the left chest cavity and caused critical airway stenosis. The pathology revealed a Gardner Fibroma, which is rarely associated with mediastinal airway obstruction.

Background: Absent pulmonary valve syndrome (APVS) is a variant of tetralogy of Fallot characterized by aneurysmal pulmonary arteries, which compresses the tracheobronchial tree, leading to respiratory symptoms. We report the mid-term outcomes of surgical correction of patients with APVS. Subject and Methods: A total of 27 patients underwent surgery between 2001 and 2015, and they were followed up for a mean period of 6.4 ± 4.1 years. Out of the 27 patients, 14 (51.9%) were infants. The median age at repair was 9.8 months. Preoperative intubation was required in six patients (22.2%), and 11 patients (40.7%) had symptoms of respiratory distress. The pulmonary valve was replaced with a valved conduit in 15 patients (55.6%), monocusp valve in 6 patients (22.2%), and a transannular patch in 6 patients (22.2%). Reduction pulmonary arterioplasty was done in all patients. Results: The overall 10-year survival was 82.1%. There was 81.1% overall freedom from re-intervention at 10 years. No statistically significant difference was found in 10-year survival (P = 0.464) and reoperation rates (P = 0.129) between valved conduit, monocusp, or transannular patch techniques. Older children had statistically significantly longer survival (P = 0.039) and freedom from re-intervention (P = 0.016) compared to infants. Patients without respiratory complications had 100% 10-year survival and 93.3% freedom from reoperation at 10 years compared to 55.6% and 60.1%, respectively, for patients with respiratory complications. Conclusion: There has been improvement in surgical results for APVS over the years. However, it still remains a challenge to manage infants and patients with persistent respiratory problems.

Background: Patients with congenital heart defects may present with concomitant defects involving other organ systems. Roughly 4 percent of this nature are airway anomalies. Presence of anomalous airways summon major challenge before the anesthesiologist, surgeon, and intensivist in the perioperative management of such patients. There is paucity of literature in the study of airway anomalies in the subset of congenital anomalous pulmonary venous connections. We present the analysis of three cases of airway anomalies in patients operated for anomalous venous drainage at our center. We hope to explicate the clinical implications and management of such rare presentations. Methods: The records of all patients who underwent surgical correction for anomalous venous return between January 2016 and January 2018 were reviewed retrospectively. The records were examined for presence of any airway issues, abnormal radiological findings, perioperative intubation or extubation issues and perioperative surgical findings. Results: Amidst the 410 cases operated for congenital heart defects in this period, 92 were operated cases for anomalous pulmonary venous return, of which 3 patients presented with airway issues. One patient had an aberrant right tracheal bronchus with normal carina and bilateral main bronchial stenosis, the second patient had a hypoplastic left lung and the third patient had congenital lobar emphysema of the left lung. Conclusion: Prudent perioperative management necessitates prior evaluation and preemptive planning for airway anomalies in patients with anomalous venous return, since they can belong to the “Malinosculation Syndrome” group, which involves anomalous communication by means of small openings between the different components of lung tissue, namely, the lung parenchyma, tracheobronchial tree, arteries, and veins.

Since the anterior translocation of the pulmonary arteries in relation to the aorta (Lecompte maneuver) was first described in 1981, its indications have continued to expand. In this review, we discuss the physiological basis and the expanding indications for this maneuver.

Teratomas are unusual tumors derived from all 3 germs cells layers: endoderm, mesoderm, and ectoderm, with varying proportions. The cervical area is exceptionally affected. We report 4 cases of cervical teratoma. The clinically and radiologically suggested diagnosis was confirmed by histology. We describe herein the main clinical, radiological, and histological aspects and outcomes of this disease. Despite its most often benign histologic nature, cervical teratoma may threaten newborn infants' life due to airway compression. A multidisciplinary approach to the disease starting at delivery is required to improve the prognosis.

Cervical teratomas are not reported quite frequently in medical literature, especially from Indian subcontinent. Prenatal diagnosis of this condition is even rarer, making the management protocols difficult. In absence of prompt intervention in the form of airway decompression, morbidity and mortality is very high. Presented here is the case of antenatal diagnosed cervical mass, which was managed successfully in immediate post-natal period with uneventful survival and normalized tumor marker levels.

A bstract Background Tetralogy of Fallot and absent pulmonary valve (TOF/APV) is associated with significant pulmonary artery dilatation and airway compression. Methods We performed a retrospective review of 73 consecutive patients who underwent repair for TOF/APV between January 2005–August 2015. Mean age was 6.4 ± 5.6 years (28 days–22 years). The right ventricular outflow tract (RVOT) was reconstructed using varied techniques. Freedom from RVOT gradients and re-operation was studied. Results There were four (5.5%) early deaths, two each in infants and older children. Median ICU stay was 2 days (range, 1–12 days). Mean ICU stay for, infants, children and adults, was 6.5 ± 6.04, 2.75 ± 2.45, and 2.33 ± 1.03 days, respectively (p = 0.0762). Median hospital stay was 6 days (range, 4 to 15 days). Mean hospital stay for, infants and children and adults was 7 ± 2, 6.75 ± 2.39, and 6.33 ± 1.63 days, respectively (p = 0.325). Mean follow up was 65 ± 36.6 months (median 56 months, range 7–126 months). On follow up echocardiography, 14 (21.21%) had no pulmonary regurgitation. 21 (31.81%) had mild PR patients, 8 (12.12%) moderate PR and 19 (28.78%) had severe PR. There were five (7.5%) reoperations. Five and ten-year survival was 95% ± 2.12 and 92.3% ± 3.45 respectively. Freedom from RVOT reoperation was 93 ± 2.62% and 89 ± 3.87% at 5 and 10 years. Conclusions In contrast to children and adults with TOF/APV, infants carry significant early mortality. But the mid-term outcome for patients who survive the initial repair of TOF/APV is acceptable. However, these patients require constant surveillance and irrespective of the methods of RVOT management, the reoperation rates are expected to be high as more of these patients survive into adulthood.

Coincidence of the Eagle syndrome and diffuse idiopathic skeletal hyperostosis can very rarely result with compression of the hypopharynx. The authors here described a very rare case of hypopharyngeal airway compression secondary to cervical osteophytes in a patient with coincidence of Eagle syndrome and diffuse idiopathic skeletal hyperostosis. Multidetector computed tomography accuracy showed compression to the hypopharyngeal air column by the Eagle syndrome and diffuse idiopathic skeletal hyperostosis.

Pediatric mediastinal tumors and cysts are rare disorders that share many similarities with adults, yet which have important differences unique to the child. Posterior mediastinal tumors are relatively more common in children than in adults and are also more likely to be malignant in children. CT imaging facilitates the diagnostic evaluation of mediastinal masses in children. Airway compression is always a concern with large mediastinal tumors in children given their relative softer and smaller airway.

Airways compression by vascular structures is one of the important comorbidities of congenital heart disease with incidence of approximately 1%-2% in children. Airways compression is a consequence of abnormal configuration of the great vessels producing a vascular ring with enlargement of normal structures (pulmonary arteries or cardiac chambers) or because of surgery. A high index of suspicion for vascular airway compression is important in children with recurrent respiratory complaints. Early diagnosis and management are essential, as chronic airway compression causes significant morbidity. As the underlying anatomical patterns tend to be highly complex, presurgical imaging assessment is essential.

To assess the clinical and imaging findings in children with severe tracheal or bronchial compression caused by abnormal thoracic configuration.Clinical and imaging findings, care, and outcome were reviewed in six patients with airway compression caused by abnormal thoracic configuration. Radiographs and magnetic resonance (MR) images were available in all patients.Mechanisms of airway compression included alteration of mediastinal anatomy and direct airway compression secondary to a narrow anteroposterior chest diameter. In three patients, the trachea was compressed at the level of the thoracic inlet. In the other three patients, the left main bronchus was compressed. Four patients underwent surgery for the thoracic deformity, with resolution of airway symptoms. In all four patients, the presence, location, and cause of airway obstruction determined at MR imaging were confirmed at surgery.Abnormal thoracic configuration, in addition to causing restrictive lung disease, can cause respiratory distress secondary to severe compression of the central airways.

Palliative airway treatments are essential to improve quality and length of life in lung cancer patients with central airway obstruction. Rigid bronchoscopy has proved to be an excellent tool to provide airway access and control in this cohort of patients. The main indication for rigid bronchoscopy in adult bronchology remains central airway obstruction due to neoplastic or non-neoplastic disease. We routinely use negative pressure ventilation (NPV) under general anaesthesia to prevent intraoperative apnoea and respiratory acidosis. This procedure allows opioid sparing, a shorter recovery time and avoids manually assisted ventilation, thereby reducing the amount of oxygen needed, while maintaining optimal surgical conditions. The major indication for NPV rigid bronchoscopy at our institution has been airway obstruction by neoplastic tracheobronchial tissue, mainly treated by laser-assisted mechanical dissection. When strictly necessary, we use silicone stents for neoplastic or cicatricial strictures, reserving metal stents to cover tracheo-oesophageal fistulae. NPV rigid bronchoscopy is an excellent tool for the endoscopic treatment of locally advanced tumours of the lung, especially when patients have exhausted the conventional therapeutic resources. Laser-assisted mechanical resection and stent placement are the most effective procedures for preserving quality of life in patients with advanced stage cancer.

This is report of a rare case of thymic hyperplasia in a 6-month-old female child with significant compression effect on the airways and shift of the mediastinum. Timely imaging study and tissue biopsy play an important role in identifying cause of anterior mediastinal mass in this age group.

A previously well man presented with acute dyspnoea and stridor necessitating tracheostomy. Nasoendoscopy showed airway compression secondary to an external lesion. …

A 6-month-old boy with congenitally corrected transposition of the great arteries, ventricular septal defect, and mild pulmonary valve stenosis presented with acute obstructive respiratory life-threatening events. Airways obstruction was caused by aneurysmal dilation of the branch pulmonary arteries compressing the carina and bronchi. The child was ventilator dependent. A double switch operation with Lecompte maneuver was performed, bringing the pulmonary arteries forward and relieving the airway compression. The child made a complete recovery and remains well 9 months later with no clinical or radiologic signs of airway compression.

Although all the well-recognized muscles of expiration are paralyzed after traumatic transection of the lower cervical cord, tetraplegic subjects can still empty their lungs actively by contracting the clavicular portion of the pectoralis major. It is not known, however, whether contraction of this muscle bundle may raise pleural pressure enough to cause dynamic compression of the intrathoracic airways, which is critical for the production of an effective cough. To investigate this question, we measured expiratory flow rate and esophageal pressure during a series of forced expiratory vital capacity (VC) maneuvers in twelve subjects with C5-8 traumatic tetraplegia and constructed isovolume-pressure flow (IVPF) curves. The curves were interpretable with certainty in nine patients. Three of them did not show any plateau of flow. On the other hand, six patients had clearcut plateaus of flow on all IVPF curves between 80-60 and 20% VC, suggesting they had dynamic airway compression. Videoendoscopic recordings in two patients confirmed trachea and main bronchi collapse during forced expiration and cough. We conclude, therefore, that contraction of the pectoralis major causes dynamic airway compression during expiratory efforts in a substantial proportion of tetraplegic subjects. Increasing the pressure-generating capacity of this muscle might thus improve the effectiveness of cough and reduce the prevalence of bronchopulmonary infections.

IMPLICATIONS: Airway compression from insertion of a transesophageal echocardiography (TEE) probe has been mostly limited to pediatric patients. We present a case of TEE-associated airway obstruction in an adult patient undergoing surgery for repair of a giant ascending aortic pseudoaneurysm.

The hybrid approach has evolved into a viable alternative to Norwood stage I procedure for hypoplastic left heart syndrome. A 4-month-old girl with DiGeorge syndrome and an unbalanced atrioventricular canal with hypoplastic left ventricle and aortic valve underwent a hybrid procedure with

Primary B-cell lymphoma of thymus is uncommon. We describe the case of a 23-year-old woman with a history of shortness of breath and distended neck veins of 1-month duration. A chest roentgenogram and computed tomographic chest scan of the showed a large anterior mediastinal mass. Tru-cut biopsy revealed primary B-cell lymphoma of thymus. She underwent chemotherapy with no symptomatic improvement. Post-chemotherapy computed tomographic scan of the chest showed no appreciable reduction in tumor size. Surgical excision was carried out with excellent results.

Airway compression is a common complication of TB lymphadenopathy in children, and the diagnostic workup of patients with suspected tracheal or bronchial stenoses includes bronchoscopy and CT (computed tomography).2 This process affords the opportunity to study aspects of CT relating to airway stenosis. Axial CT scans produce excellent resolution in the horizontal plane, but the extent of airway disease may be underestimated if only axial images are obtained. An advantage of using multidetector CT (MDCT) is the use of multiplanar reconstruction (MPR) to align the image along the longitudinal axis of the airway. There is also uncertainty if window settings affect the measurement of the airway diameter. We wished to determine if there was a significant difference between the measurements of compressed airway diameter in the axial plane compared with measurements of diameter using MPR for determining longitudinal axis of the airway; and to evaluate how measurements on lung window settings compare with soft tissue window settings.

Anterior mediastinal mass is an uncommon pathology that presents significant anaesthetic challenges because of cardiopulmonary compromise. We present a case that presented in the third trimester of pregnancy with severe breathlessness, orthopnoea, and symptoms of superior vena cava obstruction. The patient had emergency Caesarean section under epidural anaesthesia with a good outcome. The paper discusses the relevant perioperative considerations for this complex scenario and reviews reports of similar conditions., published_or_final_version

We describe 2 patients in whom symptoms of airway compression developed after arterial switch operation for correction of the transposition of the great arteries. The clinical features, diagnosis, management, and proposed mechanisms of this complication are described.

Postpneumonectomy syndrome is a rare complication secondary to postsurgical anatomic changes in the pneumonectomy space. Patients present with marked dyspnea on exertion secondary to airflow limitation from proximal airway compression and overdistention of the remaining lung because of mediastinal shift. Postpneumonectomy syndrome is treated by surgical repositioning of the mediastinum. Knowledge of the clinical and radiological features will enable prompt diagnosis and appropriate treatment.